| Time |
Session |
|
|
08:30
17:00
|
TWTC - 1F Exhibition Hall
|
|
08:30
10:00
|
-
John DenstedtCanada
Speaker
UAA Lecture: Innovations in Renal Stone SurgeryInnovations in Renal Stone Surgery
John Denstedt MD FRCSC
Professor of Urology
Schulich School of Medicine and Dentistry
Department of Surgery Western University
London Canada
Recent years have seen a burst of innovation in techniques for minimally invasive treatment of renal stones. Current guidelines recommend either shock wave lithotripsy or retrograde intrarenal surgery {RIRS} for stones smaller than 2cm and percutaneous renal stone removal for calculi greater than 2cm in maximal diameter. Progress in mini percutaneous stone removal {mPCNL} has facilitated expansion of antegrade techniques to stones smaller than 2cm while concurrently RIRS has seen indications expand to include larger stones than previously considered. Most randomized trials have demonstrated similar operating times, hospital stays and complications comparing RIRS and MPCNL however stone free rates are generally documented to be improved with a percutaneous approach.
Technology continues to advance and the development of flexible deflectable ureteral access sheaths with suction capability offer the possibility of improved stone free rates with RIRS while also decreasing intrarenal pressure, thus reducing the incidence of sepsis and other complications. This is challenging the traditional concept of limiting retrograde ureteroscopy to stones less than 2cm in diameter. This lecture will review the current literature on RIRS for intrarenal stones greater than 2cm, outlining expectations for the main parameters of stone free rate, complications and operating efficiency. Currently available technology and techniques will be presented allowing participants to take practical tips and tricks back to day to day urologic practice.
-
Allen W. ChiuTaiwan
Speaker
Reflecting on the Past, Shaping the Present, and Envisioning the Future of UAASince 1990, the Urological Association of Asia (UAA) has stood as a beacon of collaboration, innovation, and advancement in urology in Asia. As we reflect on its evolution, acknowledge its current impact, and envision its future, it becomes clear that the UAA has played - and will continue to play - a pivotal role in shaping urological care, education, and research throughout Asia. Reflecting on the path we’ve traveled together from 16 member associations and 1,000 individual members in 2014 to 28 member associations and over 4,500 individual members today - I see more than growth. I see unity, commitment, and a shared belief in something bigger than ourselves. A defining milestone was enrolling the Urological Society of Australia and New Zealand into the UAA, further enriching our diversity and strengthening our position as a truly Asia-Pacific organization. The UAA proudly supports several journals, including the International Journal of Urology, the Indian Journal of Urology, Asian Urology, which continue to shape the academic discourse. The Asian Urological Resident Course (AURC) started in 2014, in collaboration with the American Urological Association, has become a cornerstone in nurturing clinical excellence among young urologists. The Young Leadership Forum, since 2012, developed in partnership with the European Urological Association, has fostered cross-continental mentorship and exchange. These initiatives symbolize our commitment to creating a future shared across borders. We have faced challenges under the impact of COVID-19, but conquered it with resilience and shared purpose. As healthcare needs evolve and patient expectations rise, the UAA aims to: 1. Promote regional research 2. Enhance training and education 3. Strengthen partnerships 4. Champion equity in healthcare.Complex Robotic Assisted Surgery for Urinary Fistula RepairRobotic-assisted (da Vinci) surgery is increasingly used for repair of urinary fistulas, including vesicovaginal, ureterovaginal, and enterovesical fistula. It offers a minimally invasive alternative to open surgery. A case report described using the da Vinci X system to fix a vesicovaginal fistula (VVF) post-hysterectomy in 105 min with no complications, a 2 day hospital stay, and excellent patient reported quality-of-life at 12 months. A literature review including 30 cases showed robotic repair of VVF reduced blood loss and shortened hospital stays by 2 days compared to open repair. A review found that robotic repair of complex urinary fistulas is technically feasible in expert hands, with good early outcomes and less morbidity than open techniques.
This presentation illustrated the key operative procedures, inlcuding ureteral catheter placement to identify the ureteral tract, anchoring stitches on opened urinary bladder wall, robotic excision of the fistula tract, layered closure of bladder wall and adjacent organ (vagina or colon), with or without Interposition of tissue flaps (e.g. omentum or peritoneal flaps) to reinforce repair. The robot provides precise and secure ileal isolation with ICG technique for the ileal isolation, and and intracorporeal anastomosis to ureter and urinary bladder are safe. Intracorporeal bowel re-anastomosis and accessibility of the da Vinci platform is becoming more popular. The isolated ileal technique provides good urinary reconstruction (e.g., Neobladder, Augmentation Cystoplasty Ileal conduit (Bricker’s procedure), Orthotopic neobladder (Studer, Hautmann, etc.) The Role of the robot to harvestest, detubularize, and fold ileum to form bladder substitute. Suture to urethra and ureters. It is often performed entirely intracorporeally with the da Vinci Xi system.
-
Arnulf StenzlGermany
Speaker
EAU Lecture: AI to Support Informed Decision Making (INSIDE) for Improved Literature Analysis in Oncology.Robot-Assisted Radical Cystectomy and Intracorporeal Neobladder Formation
-
Stephen A. BoorjianUnited States
Speaker
AUA Lecture: 2025 Update of AUA and EAU NMIBC GuidelinesBoth the American Urological Association (AUA) and European Association of Urology (EAU) have developed guidelines for the management of non-muscle invasive bladder cancer (NMIBC). While subtle differences in several aspects of these guidelines exist which merit mentioning, both guidelines emphasis the concept of risk stratification. In particular, understanding the criteria which classifies patients with NMIBC as high risk avoids undertreatment of the patients most likely to experience disease progress. Likewise, recognizing the indications for cystectomy among high risk NMIBC patients is critical to optimize survival. Meanwhile, continued options emerge for patients classified as having BCG unresponsive NMIBC, such that knowledge of that definition as well as current management strategies for these patients facilitates contemporary practice.From Bench to Bedside - A Comprehensive Overview of Kidney CancerEvaluation of patients with a newly identified renal mass includes dedicated cross-sectional imaging for appropriate characterization. Genetic syndromes which include renal cell carcinoma (RCC) are increasingly understood, and indeed knowledge of the intracellular pathways of these conditions has facilitate rationale drug development for kidney cancer. Managing patients with a small renal mass involves a critical assessment of competing risks inherent to the tumor, the patient (underlying comorbidity status), and the proposed treatment. Renal mass biopsy may play a role in select cases for additional information/risk stratification. The safety of active surveillance is being increasingly demonstrated as longer-term follow-up matures. Meanwhile, select patients with high risk disease now have the option of adjuvant immunotherapy following surgical resection. In the setting of metastatic RCC, again risk stratification plays a critical role in the decision for – and timing of – cytoreductive nephrectomy, particularly in the contemporary era of checkpoint inhibitor therapies.Real World Experience in the Management of Upper Tract Urothelial CarcinomaThe biggest challenging in managing upper tract urothelial carcionma (UTUC) remains accurate staging of tumors at diagnosis. Given the limited ability of contemporary staging methods, clinical risk stratification models have been developed to assist in providing risk-based treatment recommendations. For example, endoscopic management (e.g., ablation) represents the recommended first line approach for patients with low risk disease. Importantly, follow-up for these patients should include endoscopic re-evaluation. The value of testing patients with UTUC for Lynch syndrome is also critical to recognize. A role for neoadjuvant chemotherapy is being increasing explored for patients classified with high-risk UTUC, while several options exist for adjuvant chemotherapy and immunotherapy for patients with adverse pathology at surgical resection. Continued investigation into prevention of postoperative intravesical recurrences in patients with UTUC is warranted given the frequency of metachronous tumor development in the bladder among these patients.Updates on MIBC and Advanced Bladder Cancer: Where do We Stand in 2025While neoadjuvant chemotherapy prior to radical cystectomy has been demonstrated with randomized trial data to improve survival for patients undergoing radical cystectomy, nevertheless utilization is often restricted by misunderstandings regarding patient eligibility factors. As such, defining eligibility criteria will facilitate increased adoption. Likewise, new data indicates a role for adjust immunotherapy in select patients following surgery as well. Moreover, important recent evidence on the role of extended lymph node dissection and the opportunities for preserving sexual function after cystectomy by modifying surgical technique are critical to review in order to optimize future patient outcomes. Further, recent advancements in systemic therapy options for patients with metastatic urothelial carcinoma have led to unprecedented survival rates.Revisit on Testicular Tumors-What we Learned from past and Prepared for the FutureGerm cell tumor (GCT) progression typically occurs in a predictable sequence of disease spread to the retroperitoneum first and then distant metastases. Understanding the role of serum tumor markers at various disease stages is critical for guideline-concordant management and to optimize patient outcomes, avoiding both undertreatment and overtreatment. For patients with seminoma, retroperitoneal lymph node dissection now represents an option for patients with low volume retroperitoneal lymph node disease, with the goal of avoiding the long-term toxicities associated with chemotherapy and radiotherapy. For patients with residual postchemotherapy masses in seminoma, increasing evidence suggests that PET scans should be utilized/interpreted with caution, and that in the absence of mass growth continued follow-up may be the strategy for most patients. Similarly, for patients with nonseminomatous GCTs (NSGCT) and equivocal retroperitoneal lymph nodes at presentation, re-scanning after an interval of approximately 6-8 weeks may be preferable to initial treatment, as many of these nodes represent benign processes and as such will resolve. Nevertheless, postchemotherapy retroperitoneal lymph node dissection remains a critical component of the management of patients with NSCGT and a residual mass. Risk Stratification and Contemporary Management of Biochemical RecurrenceBiochemical recurrence (BCR) has been reported in up to 35% of patients following radical prostatectomy. Understanding the natural history and clinicopathologic risk factors associated with disease progression is critical to facilitate an individualized treatment approach. Likewise, recognizing the details of treatment delivery with salvage radiotherapy is necessary to optimize outcomes. Further, as data emerge on the utilization of systemic therapy for non-metastatic BCR, being able to contextualize reported outcomes with patient age, comorbidity status, and disease risk will enhance appropriate care delivery.
-
Bannakij LojanapiwatThailand
Moderator
PSA Kinetics Following PADT in mHSPC. Is It a Real-World Tool for Predicting Oncologic Outcome?PSA Kinetics following Primary Androgen Deprivation Therapy
(PADT) in mHSPC. Is it a Real-world Tool for Prediction Oncologic Outcome?
Bannakij Lojanapiwat, M.D.
Professor of Urology, Chiang Mai University, Thailand.
Of recent guidelines, upfront primary androgen deprivation monotherapy or combination therapy (PADT) is recommended for the treatment of metastatic hormone sensitive prostate cancer (mHSPC). Limitation of real-world treatment such as culture difference, financial barrier, geographic access to treatment and high operation/ radiation risks associated with medical comorbidity led to underutilization of combination therapy as the standard guideline. Prognostic factors are important in clinical practice which can predict the clinical outcome that offer the pre-treatment counseling for patients to select the optimal treatment.
Prostate specific antigen (PSA) levels is one of the important key prognostic markers. PSA kinetics of nadir PSA level and time to nadir PSA following the treatment are the important role for progression to CRPC and oncologic outcome. Our study and the previous studies reported better oncologic outcome especially overall survival, cancer specific survival and time to developed CRPC in mHSPC patients received upfront PADT who decline PSA≥95% (deep responder), PSA nadir ≤ 0.2 ng/ml (low PSA nadir level), time to PSA nadir ≥ 6 month and PSA decline velocity <11 ng/ml/month.
PSA Kinetics following Primary Androgen Deprivation Therapy (PADT) is one of a real-world tool for prediction oncologic outcome in the treatment of mHSPC.
David PensonUnited States
Speaker
Comparison of Various Treatment Options for Localized Prostate CancerThere are numerous therapeutic strategies used to treat localized prostate cancer, each with unique advantages and disadvantages. Furthermore, prostate cancer itself is heterogeneous with some tumors being indolent and others being more aggressive. We will from the presentation by looking at outcomes separately in patients with favorable prognosis and those with unfavorable prognosis, based upon baseline clinical characteristics. We will first compare cancer control and mortality outcomes amongst the various options. We will then present data on patient-reported outcomes. At the conclusion of the presentation, attendees will have a better understanding of outcomes following treatment for localized prostate cancer and will be better prepared to counsel patients newly diagnosed with this common malignancy.Updates on Combination Therapy for Advanced Prostate CancerOver the past decade, there are have been significant advances in the treatment of metastatic prostate cancer. Randomized clinical trial data have demonstrated that combination therapies are superior to monotherapy in terms of cancer control and survival. Various treatment options will be discussed for metastatic castrate-sensitive and -resistant prostate cancer. These will be compared in terms of efficacy and side effect profiles to aid in treatment selection in this The Startup of An Academic Urologist - How to Build up Your Team in Clinical ResearchMany young academic urologists wish to perform clinical research at their institution. Often, however, this is challenging due to lack of resources or time. In this presentation, we will discuss how to build a clinical research program, including identifying what types of individuals need to be part of the team and what sort of resources are required for success. While American examples will often be used, information from this presentation will still be applicable globally.A Programmatic Approach to Prostate Cancer ScreeningProstate cancer screening has advanced beyond annual PSA testing. We now have numerous tools available to aid in identifying men at risk for harboring clinically significant prostate cancer, including MRI and various novel biomarkers. In this presentation, we will review these modalities and lay out a systematic approach to screening in 2025.
-
Declan MurphyAustralia
Speaker
PSMA PET Scan in Diagnosing Early/Advanced Localized Prostate Cancer Especially Comparing Various Radioactive Tracers
TICC - 3F Plenary Hall
|
-
Ho-Yee TiongSingapore
Moderator
Living kidney donation with AI - Augmented or ArtificialAt the National University Hospital, we have utilized AI to try improving our pre-operative and peri-operative management of our patients for donor nephrectomy. This presentation shares the benefit of the learning experience of using AI through a standardized procedure like donor nephrectomy.
-
Brian K. LeeUnited States
Speaker
Genetic Testing in the Evaluation of Recipient Candidates and Living Kidney DonorWith the advent of more affordable next generation sequencing with ever faster turnaround times, precision medicine has taken on a more prominent role in clinical practice. This has meant that when determining the most appropriate course of action when evaluating potential kidney transplant recipients, genetic ascertainment of the underlying cause of their ESKD/CKD has become an increasingly indispensable tool. At the same time, related living kidney donors, especially those who are young, and who may not have any manifestations of renal symptoms can now be genetically tested to reassure transplant professionals and donors and their families that they are unlikely to harbor a hereditary condition that could jeopardize their future renal function. And yet the interpretation of genetic testing results is not part of the regular nephrology/transplant curriculum, and many centers do not have readily accessible medical geneticists or genetic counselors at their disposal, making the appropriate triaging of recipient and donor candidates alike somewhat of a black box. Through this session, we hope to elucidate the tough decisions and triumphs that comes with recognizing both the powers and the limitations of using genetic tests in transplant recipient and donor evaluations. Non-Invasive Immune MonitoringThe success of kidney transplantation is dependent on the close monitoring of kidney function and the net immune status of the host recipient. Traditional biomarkers such as serum creatinine are unreliable at best, often lagging behind histologic evidence of anti-graft activity when protocol biopsies are performed which could jeopardize opportunities for clinicians to intervene timely. Surveillance renal allograft biopsies have been employed in an attempt to match clinical outcomes with histologic findings, but this invasive procedure could lead to bleeding complications and is time- and labor intensive. Better immune monitoring has recently become more widely adopted in transplant practice, and its introduction could allow closer follow-up of the recipient and shed light on the state of immune milieu.
-
Cheng-Kuang YangTaiwan
Moderator
Robotic Radical Prostatectomy: Trying to Fit the Right Surgery to the Right PatientDefinitive treatment for localized prostate cancer included radical prostatectomy and radiation. Successful criteria of radical prostatectomy have to meet oncology control, not persistent PSA after surgery without salvage therapy. MRI imaging stage and PSA density are predictors for short‐term BCR after prostatectomy. NCCN‐defined high‐risk patients with a high initial PSA 28 density, imaging stage (T3aN0M0 and T3bN0M0), and 29 pathologic stage (any N1) had a higher risk of BCR when 30 compared with other patients with undetectable PSA, while 31 those with pathologic stage (T3bN0M0 or any N1) displayed 32 a higher risk of postoperatively detectable PSA. These find‐ 33 ings may help urologists to identify patients for whom active 34 therapeutic protocols are necessary.
Alvin WeeUnited States
Speaker
How to Build Up a Strong Kidney Transplant Program with Continuing Growth?Transplantation is one of the most complex, highly regulated, multidisciplinary fields in medicine, requiring the coordination and dedication of a highly skilled and collaborative team.
At this conference, we’re honored to share our journey—highlighting the challenges, milestones, and strategic innovations that have shaped our transplant program. Through intentional planning, data-driven practices, and a strong team culture, we’ve grown to become the leading transplant center in the nation, recognized for both volume and quality outcomes.
Our hope is that by sharing our experience, we can contribute valuable insights to the transplant community and support others in advancing excellence in patient care.
Robotic Kidney Transplantation: The Way to Go?!The utilization of robotics in urologic surgery continues to grow, offering enhanced precision, improved outcomes, and faster recovery times. In the field of kidney transplantation, robotic-assisted techniques are now gaining significant momentum. The Cleveland Clinic Main Campus has emerged as the largest single center performing robotic-assisted kidney transplants annually—not only in the United States but also worldwide.
With this unparalleled experience, we are well positioned to share key advantages we have observed over traditional open surgical methods. As robotic technology continues to evolve, our experience reinforces its growing role in transforming the field of kidney transplantation and improving patient outcomes.
-
Tom LueUnited States
Speaker
Recent Advances in ED: Bridging Innovation and Clinical PracticeRecent Advances in ED: Translating Innovation to Patient Care
Tom F. Lue, MD, ScD(Hon), FACS, University of California, San Francisco, USA
Ischemic priapism and Peyronie’s disease are two longstanding challenges in urology. When not promptly and appropriately managed, both conditions frequently result in erectile dysfunction. This presentation will review the underlying pathophysiology of each condition and highlight recent innovations that have significantly advanced our clinical approach and improved patient outcomes.
Ischemic Priapism
Pathogenesis and Management of Ischemic Priapism
Although ischemic priapism can result from a variety of underlying conditions, they all converge on a final common pathway: paralysis of the intracavernous smooth muscle, leading to veno-occlusion and cessation of arterial inflow. This vascular stasis causes tissue ischemia, which, if not promptly reversed, progresses to necrosis, fibrosis, and ultimately erectile dysfunction.
When priapism is identified within 24 hours, initial management typically includes aspiration of the old cavernosal blood combined with intracavernosal injection of alpha-adrenergic agents such as diluted phenylephrine. These agents stimulate smooth muscle contraction, promoting restoration of venous outflow and arterial inflow.
However, once priapism extends beyond 24 hours, prolonged ischemia leads to marked tissue edema, severe smooth muscle dysfunction, and thrombosis of subtunical venules. At this stage, the efficacy of alpha-adrenergic agents is greatly diminished or absent, and surgical intervention becomes necessary. Various shunting procedures have been described to re-establish cavernosal blood flow by diverting it through the glans, corpus spongiosum, dorsal vein, or saphenous vein.
In some cases, intracavernous dilation procedures are employed to re-open the proximal-to-distal corporal channels and facilitate drainage through the shunt. These advanced measures aim to salvage erectile tissue and prevent long-term dysfunction.
Why Do Many Shunting Procedures Fail?
Within the body, exposed collagen acts as a key trigger for blood clotting. Shunting procedures create an opening in the tunica albuginea to divert blood flow toward the glans, corpus spongiosum, or the penile or saphenous veins. However, this procedure exposes collagen fibers in the tunica and surrounding injured erectile tissue, which initiates the coagulation cascade. As a result, blood clots can form within the shunt, causing its closure and leading to recurrence of priapism.
Innovation: Peri-Shunting Antithrombotic Therapy
Over the past decade, for priapism lasting more than 24 hours, we have routinely administered aspirin combined with low-dose heparin prior to shunting procedures— T-shunts, with or without intracavernous dilation. This is followed by a five-day regimen of aspirin and clopidogrel to maintain shunt patency during the critical post-ischemic hyperemia phase. Using this approach, we have effectively reduced the rate of priapism recurrence to approximately 10%.
Peyronie’s disease
Pathogenesis
Peyronie’s disease (PD) results from a complex cascade of molecular, cellular, and structural changes that cause fibrosis—with or without calcification—in the tunica albuginea, septum, or intracavernous struts of the penis. These fibrotic plaques decrease the tunica’s elasticity, leading to penile curvature, indentation, hourglass deformity, or shortening during erection. The resulting biomechanical disruption, along with the psychological distress it may cause, can contribute to erectile dysfunction.
Innovation-Enzyme-based Injection therapy
Xiaflex (collagenase clostridium histolyticum) is an enzyme-based injection therapy approved by the U.S. Food and Drug Administration (FDA) for Peyronie’s disease in December 2013. Administered via intralesional injection directly into the fibrotic plaque, Xiaflex contains enzymes that break down disorganized collagen and elastic fibers, gradually reducing and eliminating the plaque.
However, injection alone typically does not produce significant correction of the deformity without a subsequent modeling procedure. This procedure—performed manually or with devices such as RestoreX, PeniMaster Pro, or Andropenis—serves as a tissue expansion tool to promote remodeling of the normal tunica, helping to restore penile length and girth.
Over the past 11 years, the author has performed more than 11,000 Xiaflex injections and considers this approach superior to surgery for several reasons: (1) It eliminates plaques without creating new plaques, unlike surgical excision or incision with grafting; (2) It facilitates increases in penile length and girth through modeling, in contrast to the shortening often seen after plication procedures; (3) It avoids neurovascular damage and does not cause erectile dysfunction.
-
Geng-Long HsuTaiwan
Speaker
Penile Fibro-Voruilon Assembly and Venours Stripping Surgery for EDBackgrounds: Humans have existed on earth for 3000 centuries, so does penile fibro-vascular assembly, which is an exclusive milieu for applying Pascal's law if there is no veno-occlusive dysfunction (VOD), or older-termed venous leakage. The corpora cavernosa (CC), incorporated distal ligament, is the primary compartment for establishing bony rigidity. Despite extensive studies for centuries, the medieval illustration of penile fibro-vascular anatomy has prevailed in literature since 1519. Consequently, it has been unsuccessful in all derived penile reconstructive strategies, particularly the merit of penile venous surgery, which has been disputed since 1895, when Duncan introduced it in the United States. Recently, a penile fibro-vascular assembly was proven to be an independent compartment in the cardiovascular system. We sought to report on the male potency reconstructions, specifically the penile venous stripping for erection restoration, refined chronologically since 1985, in Taiwan.
Methods: Reviewing a four-decade journey, reciprocating between penile fibrovascular anatomy and Taiwanese penile venous stripping surgery (PVSS) strategy, from the 1986 prototype to the USPTO patent version in August 2012, we reviewed a vast repository in our 3488 surgeries since 1986. Under acupuncture-assisted local anesthesia, the acupoints of Hegu (LI4), Shou San Li (LI10), and Waiguan (TE5) are chosen routinely. All patients received dual cavernosography in which a pilot cavernosograpy demonstrated the innovative, intriguing penile venous anatomy, a PGE-1 test in between, and a pharmaco-cavernosography documented a veno-occlusive dysfunction (VOD). Among them, 3488 PVS surgeries had been performed. Neither an electrocautery nor a suction apparatus is used. All surgeries were conducted on an ambulatory basis with acupuncture-assisted local anesthesia. PVSS entailed the venous stripping of a deep dorsal vein and a pair of cavernosal veins after every emissary vein was fixed firmly closest to the outer tunica albuginea with a 6-0 nylon suture.
Meanwhile, segmental ligation was conducted on two pairs of para-arterial veins. Routinely, postoperative cavernosograms were obtained for comparison. The abridged 5-item version of the International Index of Erectile Function (IIEF-5) score system and the erection hardness scale (EHS) were used to confirm improvement in preoperative and postoperative follow-up via the INTERNET yearly. Statistically, the Wilcoxon signed rank test and Fisher's exact test were used as necessary.
Results: The operation time is 4.7±1.4 hours, varied widely between 3.5 h and 7.5 h with a mean of 4.7h. , and the blood loss is 15.8±4.6 mL. There was a significant difference (both P＜0.01) in preop. And postop. IIEF-5 and EHS scores (9.7±2.8 vs. 20.8±2.3; 1.7±0.6 vs. 3.2±0.2, respectively. Although the intracorporeal retention and erection quality improvement were profound unexceptionally, improved rate was defined as an IIEF-5 increasement of 3 scores out of 25 and EHS up warding at least one scale; accounting for 50.0 to 95.7%; however, the gratifying rate varies between 55.5% to 85.8% with available follow-up for longer than a decade. In the adolescent-onset impotence, natural coitus can be achieved in 3 out of the five patients.
Discussion and conclusion: Given that refractory ED prompted most patients to seek our PVSS, it is noteworthy that PVSS appears to be beneficial to most ED patients of all ages. Particularly, with an ultimate understanding of penile fibrovascular assembly involving the erection veins and apagogical erection process through hemodynamic research via fresh and defrosted cadaveric penises, Taiwanese PVSS warrants spreading to young surgeons.
Take-home message:
The conventional penile anatomy is merely one circumferential layer model of tunica albuginea surrounding the corpora cavernosa (CC) and one deep dorsal vein draining corporeal blood; as evidenced by research, innovative terms such as erection-related veins, penile venous stripping surgery (PVSS), and penile fibro-vascular assembly are underpinned and implemented in Taiwan.
Human penile fibrovascular assembly involves the fibrous bi-layered tunica albuginea model with a 360° inner circular and 300° outer coat surrounding the CC; the erection-related veins are one deep dorsal vein (DDV), two cavernosal veins (CVs), and four para-arterial veins. Each vein has emissaries connecting to the CC sinusoids.
The relationship between DDV, CVs, and emissaries resembles that of rattan root nodes to a yam vine: multiple smaller yams can sprout if the root remains intact, which occurs at the expense of the main vine's ability to support a single giant yam; this agricultural principle guided the design of our PVSS approach.
Taiwanese PVSS requires neither electrocautery nor suction apparatus. Although most of the medical community worldwide does not agree with it, PVSS is beneficial in correcting veno-occlusive dysfunction and has outstanding results. The traditional complications of irreversible penile numbness and deformity have been virtually negated with the venous ligation technique superseding venous cautery.
Despite not being agreed upon in most of the medical community, penile venous stripping surgery is beneficial in correcting veno-occlusive dysfunction, with outstanding results. The traditional complications of irreversible penile numbness and deformity have been virtually negated with the venous ligation technique superseding venous cautery.
Although many urological surgeons regard the PVSS surgery niche as unreachable, it is achievable, akin to the capability of performing microsurgery on a small rat. Taiwanese PVSS is likely the exclusive physiological way to ensure erection restoration and a natural way of glans expansion. So PVSS, which ought to decline AI assistance, should be shared with young surgeons.
Key Words: cavernosal vein, erectile dysfunction, deep dorsal vein, para-arterial vein, veno-occulusive dysfunction, penile venous stripping surgery, penile fibro-vascular assembly, erection-related veins
References:
1. Hsu, G. L., Chang, H. C., Molodysky, E., Hsu, C. Y., Tsai, M. H., Yin, J. H., & Chen, M. T. (2025). A detailed analysis of the penile fibro-vascular assembly. The journal of sexual medicine, 22(2), 225–234. https://doi.org/10.1093/jsxmed/qdae177
2. Cho-Hsing Chung, Ko-Shih Chang, Heng-Shuen Chen, Yi-Ying Hsieh, Yu-Hsiang Chang, Geng-Long Hsu, Mang-Hung Tsai, Jeff SC Chueh. Combining Erection Restoration and Factual Penile Enhancement Based on Revolutionary Penile Fibrovascular assembly. Journal Archivos Españoles de Urología, accepted 2025.
3. Cho-Hsing Chung, Heng-Shuen Chen, Yi-Ying Hsieh, Geng-Long Hsu, Cheng-Hsing Hsieh, Ta-Chin Lin, Jeff SC Chueh. Strategy for salvaging the shrinkage soft glans penis and impending prosthesis loss in patients with a penile implant: A case report. Journal Archivos Españoles de Urología, accepted, 2025.
4. Geng-Long Hsu: Physiological Approach to Penile Venous Stripping Surgical Procedure for Patients with Erectile Dysfunction (Patent No: US 8,240,313B2).
http://www.google.com/patents/US20110271966
5. Chang KS, Chang YK, Chung CH, et al Emergent Penile Venous Stripping for Treating Adolescent Impotence. Life 2024, 14, 762.
6. Chang KS, Chung CH, Chang YK, et al., Coil Embolization Is Not Justified for Treating Patients with Veno-Occlusive Dysfunction: Case Series and Narrative Literature Review." Life (Basel, Switzerland) 2024; 14:911-23. https:// doi.org/10.3390/life14070911
7. Hsieh CH, Huang YP, Tsai MH, et al. Tunical Outer Layer Plays an Essential Role in Penile veno-occlusive Mechanism Evidenced from Electrocautery Effects to the Corpora Cavernosa in Defrosted Human Cadavers. Urology 2015; 86:1129-1136.
8. Hsu, G-L., & Lu, H-C. (2018). Penis Structure—Erection. In M. K. Skinner (Ed.), Encyclopedia of Reproduction. vol. 1, pp. 367–375. Academic Press: Elsevier. http://dx.doi.org/10.1016/B978-0-12-801238-3.64603-2
9. Hsu GL, Hill JW, Hsieh CH, et al. Venous ligation: A novel strategy
for glans enhancement in penile prosthesis implantation. BioMed Research
International Volume 2014 (2014), Article ID 923171, 7 pages
http://dx.doi.org/10.1155/2014/923171
10. Hsu GL, Hung YP, Tsai MH, et al. Penile veins are the principal component in erectile rigidity: a study of penile venous stripping on defrosted human cadavers. J Androl 2012; 33:176-185.
11. Hsu, G-L. (2018). Erection Abnormality. In M. K. Skinner (Ed.), Encyclopedia of
Reproduction. vol. 1, pp. 382–390. Academic Press: Elsevier. http://dx.doi.org/10.1016/B978-0-12-801238-3.64374-X (Invited)
12. Hsu, G-L., & Liu, S-P. (2018). Penis Structure. In M. K. Skinner (Ed.),
Encyclopedia of Reproduction. vol. 1, pp. 357–366. Academic Press: Elsevier. http://dx.doi.org/10.1016/B978-0-12-801238-3.64602-0 (Invited)
13. Hsieh CH, Huang YP, Tsai MH, et al., Tunical Outer Layer Plays an Essential Role in Penile veno-occlusive Mechanism Evidenced from Electrocautery Effects to the Corpora Cavernosa in Defrosted Human Cadavers. Urology, 2015, volume 86, issue 6, pages 1129-1136.
14. Hsieh CH, Chen CW, Hung Meng Huang, et al. Penile venous stripping surgery is a viable option for erectile dysfunction after unsuccessful vascular interventions. Clin. Pract. (2017) 14(1): 86-94.
15. Heng-Shuen Chen, Chu-Wen Fang, Raymond WM Tsai, Chih-Yuan Hsu, Geng-Long Hsu1, Hsiu-Chen
Lu, Mang-Hung Tsai, Jeff SC Chueh. The Human Penile Fibro-vascular Assembly Requires the Integrity of
Ten Fibro-ligaments. Life submitted, 2025.
-
William J. HuangTaiwan
Speaker
Male Infertility: Challenges and Opportunities in AsiaMale infertility contributes to nearly 50% of all infertility cases, with an increasing burden observed across Asia. In parallel, a dramatic decline in birth rates has emerged in several Asian countries—including South Korea, Japan, Taiwan, and Singapore—reaching historically low total fertility rates (TFRs) of under 1.0. While multifactorial in nature, this demographic crisis underscores the urgent need to address all aspects of reproductive health, including the often-overlooked role of male infertility. Epidemiological data reveal significant regional disparities in the prevalence, diagnosis, and treatment of male infertility. Cultural stigma, limited andrology training, fragmented referral systems, and inadequate coverage of assisted reproductive technologies (ART) have impeded timely diagnosis and intervention. Environmental exposures, endocrine-disrupting chemicals, occupational heat, and increased paternal age have all been linked to declining semen quality, as evidenced by longitudinal studies showing decreased sperm concentration and motility in several urban centers across Asia. Current diagnostic tools—including semen analysis, hormone profiling, genetic testing (e.g., Y-chromosome microdeletion, karyotyping), and imaging—enable better etiological categorization. Microsurgical sperm retrieval techniques such as mTESE have provided new hope for patients with non-obstructive azoospermia, while ICSI and sperm cryopreservation have become increasingly utilized where available. Nevertheless, access remains inconsistent, particularly outside metropolitan regions. Recent integration of AI-based systems for semen evaluation, patient triage, and digital counseling offers promising strategies to improve care delivery, especially in under-resourced settings. However, data privacy, regulatory standards, and user trust continue to pose barriers to widespread implementation. Opportunities for systemic improvement include the development of regional male infertility registries, integration of andrology into national reproductive health frameworks, expansion of insurance coverage for fertility services, and public awareness campaigns to destigmatize male infertility. In light of Asia’s fertility decline, repositioning male reproductive health as a public health and demographic priority is essential for sustainable population policy and long-term healthcare planning.
The Peri-Operative Care of MIST For Prostate HyperplasiaMinimally invasive surgical therapies (MIST), particularly UroLift and Rezūm, have transformed the treatment landscape for benign prostatic hyperplasia (BPH), offering effective symptom relief with reduced morbidity and preservation of sexual function. However, optimal outcomes depend not only on procedural execution, but also on well-structured peri-operative care protocols encompassing pre-, intra-, and post-operative management. Pre-operative evaluation includes comprehensive assessment of prostate anatomy—especially size, shape, and presence of median lobe—via imaging (TRUS or cystoscopy) to determine candidacy. Careful patient selection is essential: UroLift is typically suited for prostates <80 cc without obstructive median lobes, while Rezūm accommodates broader anatomical variability but may have delayed symptom resolution. Baseline symptom scores (e.g., IPSS), uroflowmetry, and post-void residual volume establish functional benchmarks and guide patient counseling. Anesthesia planning must consider procedural setting and patient comorbidities. UroLift can often be performed under local anesthesia with light sedation, whereas Rezūm may require short general anesthesia or deeper sedation due to thermal discomfort. Appropriate selection reduces intraoperative stress and facilitates same-day discharge. Intraoperative care focuses on minimizing trauma and ensuring device precision. UroLift requires accurate deployment of implants to maintain lateral lobe retraction without compromising sphincter integrity. In Rezūm, the number and duration of vapor injections must be titrated based on lobe size and configuration to balance efficacy and tissue inflammation. Real-time visualization and standardized protocols reduce variability and improve safety. Post-operative management involves anticipating and controlling transient irritative symptoms, such as dysuria, urgency, and hematuria. Alpha-blockers and anti-inflammatory medications are commonly used for 3–7 days post-procedure. Catheterization strategies differ by technique: UroLift may avoid catheter use entirely, whereas Rezūm often requires 7-14 days of catheter drainage due to anticipated edema. Monitoring for urinary retention, UTI, or clot obstruction is critical during the early recovery phase. Follow-up care typically occurs at 2–4 weeks and includes reassessment of voiding function, symptom scores, and patient satisfaction. Reinforcement of realistic expectations is especially important with Rezūm, which may take 4–6 weeks to achieve peak efficacy. Longitudinal studies indicate sustained symptom relief and low retreatment rates when peri-operative care is standardized and patient education is emphasized. Adverse event profiles differ between techniques: UroLift is associated with less dysuria but higher retreatment rates in large prostates, while Rezūm presents higher rates of transient discomfort but favorable durability. Structured peri-operative care pathways—including patient education, standardized medication protocols, and clear complication management plans—enhance recovery, minimize adverse events, and improve overall clinical success.
TICC - 3F Banquet Hall
|
|
10:00
10:30
|
TWTC - 1F Exhibition Hall
|
|
10:30
12:00
|
-
Ryoichi Shiroki Japan
Speaker
Surgical Robot-System hinotori in Urological Surgery: Clinical Applications and Future PotentialThe hinotori system was developed by Medicaroid, the partnership between Kawasaki, a leader in the industrial robots, and Sysmex, with its abundant expertise and networks in advanced medicine, released the first made-in-Japan RAS in 2020. The hinotori has been designed to reduce interference between arms and the surgeon at bedside. Equipped with four 8-axis robotic arms, providing smooth, highly articulated movements that mimic the human hand. In addition, docking-free design allows for a wide operative field around trocars, ensuring smooth workflows for surgeons and assistants. As a made-in-Japan system, it offers high adaptability to local clinical needs and faster implementation of user feedback.
Since the first launch, more 90 systems have been installed for the clinical use, not only inside Japan but foreign countries such as Singapore and Malaysia. The first one was performed in December 2020 on prostatectomy. Since then, more than 100,000 cases performed, including urology GI surgery, gynecology and thoracic fields. In urological surgery, robot-assisted surgery has been widely and promptly accepted as a standard approach for the majority of major surgeries, including robot-assisted radical prostatectomy (RARP), partial nephrectomy (RAPN), radical nephrectomy (RARN), radical nephroureterectomy (RANU), and radical cystectomy (RARC), and has generally shown findings superior to those of conventional open and laparoscopic surgeries
In conclusion, hinotori is a cutting-edge Japanese surgical robot already in use at many medical institutions. With strong performance across various surgical specialties and growing insurance coverage, it is expected to benefit even more patients as its technology continues to evolve and its global presence expands.Comparison of Various Current Surgical Robotic Systems - Nuances, Advantages, & DrawbacksIn the field of urology, robotic surgery has gained rapid and wide acceptance as a standard surgical care in the majority of surgeries over the last decade. To date, the da Vinci surgical system has been the dominant platform in robotic surgery; however, several newly developed robotic systems have recently been introduced in routine clinical practice. We, Fujita, installed the four different kinds of robotic platform for clinical usage such as, daVinci Xi, SP, hinotori and Hugo. In this study, we want to analyze the perioperative outcomes of robotic radical prostatectomy (RARP) and characterize the differences between four platforms.
hinotori : The hinotori system was developed by Medicaroid, the partnership between Kawasaki, a leader in the industrial robots, and Sysmex, with its abundant expertise and networks in advanced medicine, released the first made-in-Japan RAS in 2020. The hinotori has a compact operation arm with eight axes of motion, one more than the DaVinci, leading to reduce interference between arms and the surgeon at bedside.
DaVinci SP : The characteristic of the SP system can operate one 3D flexible camera and three forceps through a single port, and various surgical access is possible without the external interference of the arms. The various complicated procedures have been feasible such as NOTES or transoral surgery through the narrow space without the large wound, and retroperitoneal approach like the prostatectomy and partial nephrectomy. SP system is expected to contribute to develop the high quality surgery with minimal invasiveness.
Hugo : Hugo system (Medtronic) consists of an open-site console with two arm-controllers that are operated with a grip similar to a pistol. It also has a footswitch that controls the camera, energy source, and reserve arm. The system includes four separate arm carts, each with six joints to increase the range of motion. Additionally, it uses specific 3D glasses for head tracking technology.
Despite a small case series, there seemed to need learning-curve to get familiar with systems in setting-up and surgical procedures in introductory-phase. However, all the surgical procedures were efficaciously and safely performed, resulting in the achievement of favorable perioperative outcomes surgically as well as oncologically.
In conclusion, these new robots will lead to competition and reduce the costs of RAS and will contribute to an increase in use. Robotic-assisted surgery will become more common than laparoscopic surgery especially in the field of urology.
-
Michael WongSingapore
Moderator
Introduction to Asia School of UrologyAsian School of Urology 2022-2026 – New initiatives
Dr Michael YC Wong
Principal Director of ASU 2022-2026
President Endourological Society and WCET 2026
Introduction
Asian School of Urology (ASU) officially started in 1999 with the appointment of her first director Prof Pichai Bunyaratavej from Thailand (1999-2002) Subsequent directors were Dato Dr Rohan Malek from Malaysia (2002-2006) Prof Foo Keong Tatt from Singapore (2006-2010) Prof Rainy Umbas from Indonesia (2010-2014 ) and Prof Shin Egawa from Japan ( 2014-2022 ).
One of the highlights of the ASU in the early days were the organization of several workshops outside of UAA congress by three active sub-specialty sections of UAA namely Asian society of Endourology (over 16 workshops held from 1998-2008), Asian Society of Female Urology and Asia-Pacific society of Uro-Oncology. Other subspecialty sections were subsequently introduced and have matured very well including Asian Society of UTI and STI, Asian-Pacific Society of Andrological and Reconstructive Urology Surgeons.
In the last 8 years, ASU has seen tremendous growth under the steady leadership of Prof Shin Egawa with introduction of UAA lecturers at national Meetings and further maturation of the subspecialty sections of UAA e.g., Conversion of Asian society of endourology to Asian Robotic Urological Society to reflect the growth and development of UAA. During the past 8 years, ASU-South-East Asia section has also managed to organize 15 physical workshops and 4 webinars outside of UAA congress.
The Growth Trajectory for the next 4 years 2022-2026
There are many areas where ASU can grow further. Bearing in mind our limited resources and our excellent relationships with the world urological leaders at this point in our history.
There are three areas which I will focus on. Please remember that ASU is always open to other new initiatives as we must stay relevant to our Asian urological community.
1. Lasting and strong Relationships
1.1 AUA. Over a dish of chili crab with AUA secretary general Gopal Badlani, we explored the common desire to elevate Asian Urology and strengthen UAA Family. This led to our first joint UAA-AUA residency course at UAA Singapore 2016. After successful completion, a MOU was signed at AUA 2017 with Richard Babayan, Manoj Monga, Allen Chiu and myself in attendance. The AURC at UAA Hong Kong under Prof Eddie Chan was the result of this signed MOU. We are extremely grateful for the generosity of AUA for this program. What may not be obvious is that Gopal Badlani, Manoj Monga, John Denstedt and I served as faculty and board directors at WCE. We will sign the extension MOU in 2023 for another three years.
1.2 EAU. We have a very successful UAA-EAU Youth program since UAA Thailand 2012. This has been the work of several UAA senior members. From 2023, we are exploring joint webinars with EAU to build on this relationship.
1.3 SIU and WCE. We will further explore options based on available resources and manpower. Joint Webinar are planned for early 2026
2. Education Platform for Asian Urology Residents
From 2023, we will continue to grow our relationship with BJUI. BJUI has developed a world class online learning platform with tremendous investments since 2013. This platform is called BJUI Knowledge. ASU will reach out to all Asian residents via their national urological association president and secretary to encourage every resident to sign up for a free access to more than 420 interactive 30-minute modules covering the whole urology syllabus suitable for learning, exit exams and recertification exams. I am personally involved in developing all modules under Endourology and urolithiasis Section and have been associate editor since May 2013. The modest aim is for at least 10 residents per country to sign up by UAA 2023. We will report progress at each UAA council meeting. Pls see attached information and if there are any questions pls email me personally at email@drmichaelwong.com
3. Re-Strategize Training cum fellowship sites for ASU.
3.1 In the past we have always talked about the possibility about training sites for UAA and ASU. It has always been a difficult task due to financial and multiple logistics issues.
3.2 What can we do that is possible? Let us consider two options in the next 4 years.
3.3 For the last 6 years a group of Asian urologists started AUGTEG to design and provide two-day surgical training which includes lectures as well as dry and wet lab to develop surgical skills. AUSTEG has direct access to physical training centres in Thailand, South Korea, and China.
ASU will work with AUGTEC to pool resources since we are the same people working on both sides e.g., Anthony Ng (chairman of AUSTEG) Michael Wong (vice chairman) Eddie Chan (treasurer). AUGTEG is registered in HK.
3.4 The second option is to recognise elected university or training Asian centres to allow an attachment for young urologist post residency in a flexible format. ASU will recognise officially these sites as endorsed by UAA. At UAA 2025 , several potential ASU/UAA fellowship sites directors will be presenting their programmes to kickstart this initiative
4. In conclusion, ASU will continue to grow and serve the Asian Urological Community. The above initiatives are only the beginning of a next chapter. Can you contribute your ideas and current available resources for this purpose? If you can, Pls email me personally at email@drmichaelwong.com
Which Position is the Best for PCNL in 2025?With tremendous advances in both technique and technology , the MIS approach to staghorn calculi has evolved significantly over the last 30 years.
It is timely to review all the landmark articles on patient positioning as this ultimately determines renal access which in turn plays a major role in stone free rates. We will gain much insight as we debate and attempt to answer the question of which position is best in 2026!
Ketan BadaniUnited States
Speaker
Expanding horizons: SP for complex RAPNThe Future of Urological Robotic SurgerySingle-Port Robotic Partial Nephrectomy for Multiple or Large Renal TumorsHow to Standardize Training by AI-Learning from The Best Practice of Urological Robotic SurgerySP Partial Nephrectomy
-
Rajeev KumarIndia
Moderator
Troubleshooting in Endoscopic Stone Surgery: How to Handle Unexpected Challenges in RIRS and ECIRSProstate Cancer Nomograms and Their Application in Asian MenNomograms help to predict outcomes in individual patients rather than whole populations and are an important part of evaluation and treatment decision making. Various nomograms have been developed in malignancies to predict and prognosticate clinical outcomes such as severity of disease, overall survival, and recurrence-free survival. In prostate cancer, nomograms were developed for determining need for biopsy, disease course, need for adjuvant therapy, and outcomes.
Most of these predictive nomograms were based on Caucasian populations. Prostate cancer is significantly affected by race, and Asian men have a significantly different racial and genetic susceptibility compared to Caucasians, raising the concern about the generalizability of these nomograms.
There are very few studies that have evaluated the applicability and validity of the existing nomograms in in Asian men. Most have found significant differences in the performance in this population. Thus, relying on such nomograms for treating Asian men may not be appropriate and collaborative efforts are required within Asian countries to develop locally relevant nomograms.What Is Critical Appraisal?Critical appraisal is the process of systematically evaluating research studies to assess their validity, relevance, and trustworthiness. The goal is to determine whether a study’s results are credible and useful for clinical decision-making, research, or policy. This has become increasingly important as there has been a massive increase in the number of scientific journals and not all published research is of equal quality. Critical appraisal helps healthcare professionals avoid being misled by poor-quality studies, make evidence-based decisions and improve patient outcomes.
The key purposes are to assess validity of the study and its results and determine applicability to the specific population. It involves assessing the study design, methodological quality, completeness of reporting, potential sources of bias and potential for misconduct.
There are number of reporting guidelines that can be used for performing critical appraisal. Additionally, being aware of essential reporting standards and common problems with studies can help readers make informed decisions.Scientific Misconduct and PitfallsNo abstractExample of the “Ideal” AbstractNo Abstract
Simone CrivellaroUnited States
Speaker
Single-Port vs. Multi-Port Robotic Prostatectomy: Balancing Innovation, Precision, and OutcomesThe Application & Limitation of Urological SP SurgerySingle Port Retroperitoneal Partial NephrectomySingle Port Prostate Surgery
-
Masatoshi EtoJapan
Speaker
Current Status & Future Perspective of Surgical Navigation in Robotic SurgeryRobot-assisted partial nephrectomy (RAPN) is a standard treatment for small renal cancer, however, the number of reports on the development of the image supported system and its effectiveness is small. The key point in the procedure of RAPN is to reliably identify renal artery in a space with few landmarks and to resect a tumor. To performe RAPN safely and reliably, we have already developed a surgical navigation specialized for RAPN, and published its usefulness in daVinci surgical systems. In this lecture, I would like to talk our recent projects updating our current navigation system. The first project focuses on 3D navigation using real-time forceps tracking. The second project is to develop an AI-based autonomous registration method for surgical navigation in RAPN. I hope that these 2 projects will further enhance the usefulness of our navigation system in RAPN.
-
Chi-Fai NgHong Kong, China
Speaker
Novel Robotic Surgery PlatformsOver the past decades, robotic surgery has become an essential approach in urological care. The recent blooming of different robotic platforms, in particular in Asian countries, has helped popularize robotic surgery in less developed countries. The introduction of robotic technology in endoluminal surgery has also helped to open up opportunities to further improve endourology. In the future, the incorporation of AI in robotic systems will help upgrade the standard of care in urology.
-
TICC - 3F Plenary Hall
|
-
John DavisUnited States
Speaker
Open Surgery Training: Is It Necessary in the Era of Robotics?Open surgery training in the era of robotics may or may not be a training environment that urology has control of, given worldwide access to robotic or at least laparoscopic techniques and strong patient preference. There may be some applications where a given experienced urologist can prefer open over minimally invasive surgery (MIS), such as radical cystectomy, or indications possibly outside of MIS feasibility such as large renal tumors with caval thrombus. Specific to training and expertise, there are 3 principle features of surgical skills desired: 1) knowing ideal exposure, 2) recognition of surgical planes, and 3) knowing anatomy before it can be seen. Although some trainees may only see MIS for certain indications, open surgery may expedite the process. There are no human studies identified on the topic, but a skills lab study was instructive (Farah, J Surgical Education 2023) showing that interns with open and MIS training performed higher comparing pre-intern to post intern bootcamp skills. The benefits of a solid training pathway including open experience are to move trainees towards the faster-to-progress part of the learning curve such that the attending can offer a safe training environment while moving the case along efficiently.The Future of Surgical Skills Evaluation: What Is on Your Wish List?Surgical skills training vary significantly by region with some systems putting trainees on a timed set of years, while others apprentice trainees until meeting a threshold for skills. Early training assessments were basic timed events with qualitative scores (subject to strong attending selection for success). Trainees should experience and/or study the key pitfalls to avoid and performance goals. Surgical simulation can be highly useful, but tend to improve only certain skills and not full case needs. Updated simulation moves from digital to hands on surgical models and may move the needle towards human experience. Training can be augmented with descriptors of surgical gestures and measuring which ones are most effective. The experience for the trainee is often depicted as an "autonomy gap" whereby the training desires to have case control, possibly before they are ready. Progression can be measured by descriptors of performance from assistance through full performance without coaching. The next frontier will be artificial intelligence guided measurement where specific performances can be characterized and diagnosed for success. My ultimate wishlist would be for methods to correlate skills to outcomes, optimized curricula, and a specific pathway to correct underperformance.Tips and Tricks in Challenging Cases of Robotic Radical ProstatectomyThere are many specific challenges with robotic radical prostatectomy (RARP) that can be described and illustrated--the most 5 common are 1) difficulty access, 2) obesity, 3) pubic arch interference, 4) anatomic challenges, and 5) reconstruction challenges. In this video sample, we demonstrate 2 challenges: obesity requiring a pelvic lymph node dissection and significant pelvic de-fatting to identify the proper surgical landmarks. Next a massive sized prostate that has had a partial transurethral resection--together presenting challenges with landmarks, a difficult bladder neck to diagnose, and final reconstruction challenges.
-
Véronique PhéFrance
Speaker
New Artificial Urinary SphinterStress urinary incontinence remains a major quality-of-life concern, particularly following pelvic surgery. Despite being the gold standard, the AMS 800 artificial urinary sphincter (AUS) presents significant limitations, including mechanical failure, urethral atrophy, and challenges for elderly or disabled patients. Recent innovations in AUS design now incorporate mechatronics, remote control, adaptive pressure systems, and miniaturized components aimed at improving usability, autonomy, and continence outcomes. This presentation reviews the current landscape of next-generation AUS, focusing on ARTUS, UroActive®, and other devices under clinical evaluation. We discuss preclinical and first-in-human data, regulatory pathways, patient-reported preferences, and remaining barriers such as infection risks and training requirements. Intelligent, connected AUS devices hold promise to transform continence care after decades of technological stagnation.Choosing between Laparoscopic Sacrocolpopexy and Lateral Suspension: Weighing the Pros and ConsPelvic organ prolapse (POP) is a common condition requiring surgical intervention to restore apical support. Among minimally invasive options, laparoscopic sacrocolpopexy (LSCP) remains the gold standard, while laparoscopic lateral suspension (LLS) is gaining renewed interest for its reduced invasiveness and simplified technique. This presentation compares LSCP and LLS across multiple dimensions: anatomical restoration, functional outcomes, complication profiles, patient selection, and surgical learning curves. LSCP offers robust long-term results and better posterior compartment support but carries increased operative complexity. LLS provides effective anterior/apical correction with fewer vascular risks and a shorter learning curve. Both techniques have comparable mesh exposure rates and subjective success. Individualized decision-making based on patient anatomy, comorbidities, and surgeon expertise remains key. Emerging technologies and robotic assistance may further refine these approaches in the future.Robotic Novel Artificial Urinary Sphincter ImplantationThis video shows a step by step robotic artificial urinary sphincter implantation in women using AMS800 and Artus devices.First robot-assisted implantation of ARTUS (Affluent Medical) electromechanical artificial urinary sphincter in a female cadaverIntroduction
Artificial urinary sphincters (AUS) are effective tools for the treatment of female stress urinary incontinence. Nonetheless, hydraulic sphincters present with some limitations: complex and time-consuming preparation, need for preserved manual dexterity and constant pressure exertion on the bladder neck. The ARTUS® Artificial Urinary Sphincter is a novel electro-mechanical device designed to overcome these limitations thanks to its rapid and straight-forward implantation, intuitive remotely controlled manipulation and continuously adjustable cuff pressure.
Materials and methods
The ARTUS® system is currently under pre-market investigation in men, in an interventional, prospective, single arm, multicentric, international study. A cadaver lab session was carried out in Decembre 2024 to test the technical feasibility of ARTUS® implantation in female patients. The procedure was performed by an expert surgeon with extensive experience in AUS implantation and robotic surgery.
Results
One female patient was successfully implanted during the session. The technique has been developed following the principles of the traditional robot-assisted AUS implantation: the patient is placed in gynecological 23° Trendelenburg position. The robot has a 4-arms configuration. The procedure starts with the dissection of the vesicovaginal plane, to approach the bladder neck posteriorly. The lateral surfaces of the bladder neck are developed on both sides. The anterior peritoneum is opened to gain access to the antero-lateral surfaces of the bladder. The separation of the bladder neck from the vagina is performed through dissection of the pre-vaginal fascia bilaterally. The cuff is introduced and it is passed through the antero-lateral peri-vesical spaces, sliding behind the bladder neck from the right side to the left side. The anterior peritoneum is opened to gain access to the anterior surface of the bladder neck. The cuff is closed anteriorly, passing the transmission line inside the hole at the distal part of the cuff. The tightening around the bladder neck is achieved by pulling the transmission cable through. An optimal adjustment of the cuff around the bladder neck is provided tightening the ARTUS cuff clamping notch. Then, a supra-pubic 4 cm skin incision is made to implant the control unit. The tip of the cuff is passed outside through the incision. A lodge is prepared incising along the external oblique muscle aponeurosis. The cuff is connected to the control unit and a test with the remote control is performed to verify the functioning of the system. Finally, the control unit is placed into the lodge, anchored with non-absorbable sutures to the aponeurosis.
Conclusions
Robot-assisted ARTUS® implantation is technically feasible in female patients. This straight-forward technique may reduce operative time. The device has the potential to reduce the pressure and facilitate manipulation in patients with impaired dexterity.
-
Howard GoldmanUnited States
Speaker
Anti-Cholinergics: Does Treating the Bladder Put the Brain at Risk?Recent evidence suggests an association between Overactive Bladder Anticholinergic medication and dementia. Do these medications really increase one's risk of dementia. We will examine the evidence.Surgical Treatments for Recurrent SUI/POPEven the best of surgeon's will have patients who have recurrence after a stress incontinence or pelvic organ prolapse procedure. If the recurrent is bothersome the patient may need repeat surgery. How to decide on the ideal surgery for recurrent symptoms will be examined
-
Tai-Lung ChaTaiwan
Speaker
Novel Target for GU Cancer Metastasis and TherapeuticsCancer progression is shaped by both cell-intrinsic adaptations and complex extrinsic interactions within the tumor microenvironment (TME). Here, we identify a transmembrane protein, Meta1, as a shared therapeutic target that exhibits a Janus-like role: promoting malignant phenotypes in cancer cells while restraining tumor-supportive functions in non-cancerous stromal and immune cells. Meta1 is expressed in both compartments of the TME, orchestrating a dual program that supports metastasis and immune evasion. Mechanistically, we uncovered a malignancy-promoting factor (MPF) that acts as a functional ligand for Meta1, selectively enhancing pro-invasive signaling in cancer cells. We further identify Meta1 as an unconventional G protein–coupled receptor (GPCR) that plays as an accelerator in cancer cells of the TME. Meta1 interacts with Rho-GDI and Gαq to activate RhoA-mediated cytoskeletal remodeling and amoeboid migration, facilitating metastatic dissemination. We further identify MPF binding to Meta1 initiates Gβγ signaling, elevating intracellular cAMP and activating Rap1, thereby amplifying cell motility and metastatic potential. Leveraging the Meta1–MPF interaction, we designed MPF-derived peptides that specifically bind Meta1 and serve as the basis for a novel peptide-based PROTAC, which efficiently induces degradation of Meta1 and abrogates its pro-metastatic functions. Our study unveils Meta1 as an atypical GPCR with canonical signaling capacity and topological divergence, representing a shared and targetable vulnerability that bridges cancer cell-intrinsic adaptation with extrinsic TME communication. These findings establish the Meta1–MPF axis as a compelling therapeutic target for suppressing metastasis and reprogramming the TME.
-
Chun-Hou LiaoTaiwan
Speaker
Regeneration Medicine in Urology - A Promising Future or Hoax?Regenerative medicine comprises therapeutic strategies aimed at restoring tissue structure and function, rather than merely alleviating symptoms. By deploying cells, biomaterials, bioactive molecules, or combinations thereof, these interventions stimulate the body’s intrinsic repair mechanisms. This paradigm extends beyond traditional symptomatic treatment, offering the potential for true self-healing and organ reconstruction—ultimately prioritizing cure over chronic disease management.
Cell-based therapy has emerged as a promising intervention for various urogenital disorders, including erectile dysfunction (ED), bladder dysfunction, and male infertility. Current clinical research primarily focuses on mesenchymal stem cells (MSCs), investigating their safety, tolerability, and preliminary efficacy. Although early-phase studies suggest functional benefits—such as improved hemodynamics and tissue regeneration—most programs remain in preclinical or early clinical stages. A critical limitation remains the lack of standardization in MSC source, dose, and delivery route.
Among alternative sources, human amniotic fluid-derived stem cells (hAFSCs) have shown particular promise. In preclinical models of cavernous nerve injury, hAFSCs demonstrated prolonged retention in penile tissue and in-situ differentiation into α-smooth muscle actin-positive corporal smooth muscle cells, effectively replacing damaged tissue and restoring function. These findings represent an encouraging step toward curative therapy. However, the mechanisms governing their in vivo behavior—such as engraftment, differentiation, and immunogenicity—will ultimately determine their clinical translatability and therapeutic stability. Whether cell-based approaches can evolve from experimental platforms into routine clinical care remains a central question.
Platelet-Rich Plasma (PRP)
Platelet-rich plasma (PRP) is an autologous biologic product enriched with supraphysiologic levels of platelets, growth factors, chemokines, and extracellular vesicles. Upon activation, PRP releases a bioactive cocktail that promotes angiogenesis, neuroregeneration, and antifibrotic remodeling—key processes in the restoration of urogenital tissues.
In rodent models of cavernous nerve injury, PRP has been shown to preserve corporal sinusoidal endothelial cells and axonal scaffolds, while restoring erectile hemodynamics. Clinical studies further support PRP's safety in humans and report variable but promising improvements in IIEF scores following intracavernous injection. Nevertheless, the therapeutic response appears heterogeneous, likely influenced by patient factors, PRP preparation techniques, and injection protocols. Beyond ED, PRP has shown potential in other urologic indications such as stress urinary incontinence (SUI), interstitial cystitis/bladder pain syndrome (IC/BPS), and chronic pelvic pain, where it may contribute to tissue regeneration and symptom relief. However, broader adoption will require the establishment of individualized blood-quality metrics, standardized preparation methods, and randomized controlled trials demonstrating durable benefit.
Emerging Regenerative Strategies
Beyond cell-based and autologous biologics, a suite of innovative regenerative technologies is progressing from bench to bedside. These include:
Energy-based devices such as low-intensity extracorporeal shock wave therapy (Li-ESWT), which promotes neovascularization and tissue regeneration via mechanotransduction pathways.
Gene therapies, targeting dysfunctional or absent proteins in disorders like overactive bladder.
Smart biomaterials, capable of delivering cells or bioactive molecules in a controlled, responsive manner.
Extracellular vesicle (EV)-based therapeutics, which leverage cell-free vesicles derived from MSCs or urine-derived stem cells. These EVs carry signaling molecules (e.g., microRNAs, cytokines, growth factors) that mimic the paracrine effects of stem cells, offering a potentially safer and more scalable alternative to cell transplantation.
In preclinical models of ED and bladder dysfunction, EVs have demonstrated the capacity to promote smooth muscle regeneration, nerve sprouting, and fibrosis reduction, with functional improvements comparable to stem cell therapy.
Regenerative medicine has propelled the field of urologic tissue repair from theoretical promise to an early clinical reality. While substantial challenges remain—including the need for deeper mechanistic insight, protocol standardization, and regulatory clarity—the field is advancing rapidly. The convergence of cell therapy, PRP, EVs, and device-based modalities is creating a multifaceted toolkit for urologic regeneration. With continued scientific rigor, large-scale clinical trials, and interdisciplinary collaboration, regenerative medicine holds the potential to shift urologic care from chronic symptomatic management to durable, tissue-level cure.Stem Cell Therapy: Advancements and Clinical Insights for Erectile Dysfunction Treatment Erectile dysfunction (ED)—defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity—affects over 150 million men worldwide. While phosphodiesterase-5 inhibitors (PDE5is) remain the first-line treatment, many patients, particularly those with diabetes, age-related vascular decline, or neuropathy following radical prostatectomy, show suboptimal responses. Consequently, regenerative medicine—particularly stem-cell therapy—has gained interest for its potential to address the root causes of ED rather than merely managing symptoms.
Stem-cell therapy offers a multifaceted approach to treating ED through neuroregeneration, angiogenesis, anti-apoptotic signaling, and fibrosis inhibition. Once introduced into the target tissue, stem cells can differentiate into specific cell types or exert paracrine effects via secretion of growth factors and extracellular vesicles. Among the various sources studied, bone marrow-derived mesenchymal stem cells (BM-MSCs), adipose-derived stem cells (ADSCs), and umbilical cord-derived MSCs (UC-MSCs) have been most extensively explored.
Preclinical studies consistently demonstrate that MSC-based therapies enhance cavernous nerve regeneration, suppress fibrosis, and preserve endothelial integrity. In rat models of diabetes- or nerve-injury-induced ED, intracavernosal injections of ADSCs or BM-MSCs significantly restore intracavernosal pressure (ICP) and improve corpus cavernosum histology. Phase I/II clinical trials also support the safety and preliminary efficacy of stem-cell approaches. For example, in men with diabetic ED treated with autologous BM-MSCs, significant improvements in International Index of Erectile Function-5 (IIEF-5) scores and penile arterial flow have been reported without major adverse events. Similarly, ADSC therapy in post-prostatectomy ED has shown encouraging short-term results. However, large-scale trials are needed to clarify long-term efficacy, immune responses, and safety profiles.
Human amniotic fluid stem cells (hAFSCs) represent a promising alternative, offering characteristics that bridge embryonic and adult stem-cell profiles. These include broad multipotency, high proliferation, and low immunogenicity—traits ideal for allogeneic use and neuroregenerative purposes. Notably, hAFSCs secrete potent regenerative mediators such as brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), and insulin-like growth factor-1 (IGF-1), all of which support neurovascular repair and smooth muscle integrity. Our recent studies demonstrate, for the first time, that hAFSCs persist long-term in penile tissue and can differentiate into cavernous smooth-muscle cells, effectively replacing damaged tissue and improving erectile function even in chronic neurogenic ED models.
Despite these advantages, our findings did not reveal in-vivo homing of hAFSCs to nerve injury sites or differentiation into neural tissue. This suggests a need for future studies to identify the specific microenvironmental cues required to induce such responses. Additionally, combining hAFSCs with platelet-rich plasma (PRP) may provide synergistic benefits—enhancing stem-cell homing, paracrine signaling, and in-vivo differentiation—thereby advancing a more effective, scalable, and safe therapeutic strategy.
-
Yao-Chi ChuangTaiwan
Moderator
Road to Excellent ResearchYao Chi Chuang, Professor of Urology, Kaohsiung Chang Gung Memorial Hospital, and National Sun Yat-sen University Taiwan.
Medical research is what allows doctors to explore unmet medical need and decide how to best treat patients. It is what makes the development of new diagnostic tools, new biomarkers, new medicines, and new procedures. Without medical research, we would not be able to creative new knowledge and decide if new treatments are better than our current treatments.
There are some Tips on what to do about what research is and how to get into it:
1. Ask a good question from your daily practice, what is unmet medical need?
2. Search the old literature of your research interests- what is known? What is unknown?
3. Find a new method to solve your question or an old method but applying to a new field.
4. Start from jointing a pre-planned research project, and join a research collaborative.
5. Try to be an independent researcher from a small project without funding support, retrospective study.
6. Try to get funding support from your institute, national grant, or industry.
As a young doctor, it’s important to look after yourself and maintain a healthy balance between daily practice and research work. There is a range of options for doctors interested in research, from smaller time commitments as a co-investigator to longer-term projects and experience as chief investigator. Research works are all optional activities, so do what you can but don’t overwhelm yourself. Road to Excellent Research
Chawnshang ChangUnited States
Speaker
The Roles of Androgen Receptor in Bladder and Kidney Cancers1- Study why prostate cancer (PCa) may develop to the castration-resistant PCa, and develop new therapy to overcome the CRPC.
2- Study the roles of androgen receptor in the bladder cancer early development and later metastasis stage.
3- Cloning the 2nd androgen receptor in the bladder cancer
TICC - 3F Banquet Hall
|
Diagnosis of Uncomplicated UTIs and Genital Infections
-
Stephen S. YangTaiwan
Moderator
UTI & Hydronephrosis: What's New and Asian Guideline UpdateHydronephrosis is a common urological condition in both adults and children. It is frequently associated with urinary tract infection (UTI). However, not all hydronephrosis means upper urinary tract obstruction (UUTO). So, differentiating hydronephrosis into pathological or physiological is important. In pathological hydronephrosis or UUTO, risk factors of UTI should be identified. While in physiological UTI, no further study is required.
In this lecture, classification of upper urinary tract dilatation will be introduced, including SFU and UTD system. Other than intra-venous pyelourography, diuretic renal scan can be useful in differentiating hydronephrosis into physiological or pathological hydronephrosis. Pitfalls in interpreting diuretic renogram will be discussed. A brief review of risk factors of UTI will be done. Finally, Asian guideline on UTI will be updated.
-
-
Shingo YamamotoJapan
Speaker
Changes of the Bacterial Resistance from Uncomplicated Cystitis in JapanThe spread of antimicrobial resistance (AMR) is an increasing threat to all of humanity. Southeast and South Asian countries are among the world's leading AMR-endemic countries, with advanced AMR spreading through various international routes.
Considering the mass administration of antibiotics to livestock and pets, and the spread of antibiotics and drug-resistant bacteria in the environment, measures to combat AMR cannot be completed within the human medical field alone. It is necessary to clarify the concept of the One Health approach and for various sectors, including human medical fields (such as veterinary medicine and the environment), to work together toward the same goal.
When Japan's infectious disease control guidelines were published in 2011, fluoroquinolones were positioned as the first-choice drug for the treatment of acute uncomplicated cystitis in both pre- and postmenopausal women, because they are highly effective against both gram-negative and gram-positive bacteria.
However, quinolone-resistant and ESBL-producing strains of Gram-negative bacteria, mainly E. coli, are increasing year by year, and many ESBL-producing strains are quinolone-resistant. Therefore, it is considered that the use of cephalosporins and quinolones should be severely restricted, and it is necessary to discuss the important issue of appropriate use of antibiotics.
-
Chia-Hung LiuTaiwan
Speaker
Integrated Chip Provide Rapid Identification of UropathogenThe present study proposes a unique approach for the quick and cost-effective detection of Escherichia coli (E. coli) in urine samples using disposable gold electrode sensing chips. Spectrophotometry and plate counting demonstrated a significant linear correlation coefficient of 0.98986 between absorbance values and E. coli concentration. The electrochemical detection approach used modified electrodes to increase sensitivity. The method used to address cyclic voltammetry (CV) was not effective in depicting the peaks involved in breaking down the bacterial cell wall barrier using a permeabilizer. Square wave voltammetry (SWV) was used to identify changes in the p-nitrophenyl-β-D-galactopyranoside (p-APG) oxidation peak, which served as evidence of the successful integration and hydrolysis of β-galactosidase (β-gal). Both modified and unmodified gold electrodes showed an inversely proportional oxidation peak at 500 mV for p-PAG in E. Coli experiments employing SWV, with the modified electrodes showing greater sensitivity. During clinical testing, the proposed biosensor successfully detected urine bacterial counts with a sensitivity of about 75 colony-forming units per millilitre (cfu/ml), despite difficulties in detecting extremely low E. coli concentrations. The use of electrochemical techniques resulted in a significant decrease in experimental time, allowing real-time analysis for useful applications in the detection of bacteria in urine.
-
-
-
Pin-Hui LeeTaiwan
Speaker
HIV Screening through the Nation-Wide Sexual Health Friendly Clinical Network: Taiwan ExperiencesAs of the end of 2024, Taiwan has accumulated 45,255 HIV notifications since 1984. The number of people living with HIV has been more than 36000. Analysis by age group highlights that the majority of new HIV cases occur among individuals engaging in unsafe sexual behaviors, accounting for over 90% of transmissions. Despite ongoing efforts, undiagnosed HIV infections remain a public health challenge. Estimates using the CD4 depletion model, recommended by the U.S. CDC, show varying undiagnosed rates across age groups, especially for age of 13-35 years. Taiwan has made considerable progress toward the UNAIDS 95–95–95 targets for 2030. In 2024, estimated 92% of people living with HIV were aware of their status, 96% of those diagnosed were receiving treatment, and 95% of treated individuals had achieved viral suppression.
To strengthen early diagnosis, Taiwan has implemented various HIV screening programs especially through the B1 program, which promotes comprehensive HIV screening for individuals with STIs, also including acute viral hepatitis A,B,C, or substance use disorders. Education and promotion of the B1 program through the medical professional societies to organize the sexual health friendly clinical network has substantially increased the accessibility of HIV testing. The diagnostic process involves a combination of antigen/antibody screening, immunochromatographic tests, and nucleic acid testing. Healthcare institutions are incentivized through the reimbursement system.
The role of urology specialists is particularly emphasized. Between 2019 and 2024, urology clinics and hospitals contributed significantly to the B1 program of HIV testing. The highest HIV positivity rates in these settings were linked to patients diagnosed with syphilis, chlamydia, and condyloma acuminatum (genital warts). Physicians are encouraged to offer HIV testing and health education to at-risk patients and to invite their partners for screening and treatment.
In summary, Taiwan continues to advance in its response to the HIV epidemic by improving diagnostic coverage, optimizing care pathways, and engaging frontline specialties such as urology. Emphasis on integrated care models and proactive partner notification are key strategies moving forward in achieving national and international targets for HIV control.
-
Sang-Rak BaeKorea (Republic of)
Speaker
HPV Vaccination in Men, Asia and the WorldHPV Vaccination in Men: Status in Asia and the World
Human papillomavirus (HPV) comprises a group of over 200 virus types, among which certain high-risk types are known to cause genital warts and various cancers. Persistent infection with high-risk HPV types is a leading cause of cervical cancer and is also associated with vulvar, vaginal, oral/oropharyngeal, penile, and anal cancers. Approximately 5.2% of all cancers globally—amounting to around 600,000 new cases annually—are attributed to HPV infection. Prophylactic vaccination remains the most effective method to prevent these HPV-related malignancies. In the case of cervical cancer, HPV screening and treatment of precancerous lesions are also recognized as effective preventive strategies. However, due to the absence of reliable screening methods for HPV-related conditions in men, the burden of male HPV infection has often been overlooked.
As of 2025, around 149 countries have implemented national HPV vaccination programs, of which 82 offer gender-neutral vaccination (GNV). In Asia, Mongolia, Bhutan, the UAE, Qatar, and Kuwait have adopted GNV, and Taiwan is scheduled to expand vaccination to males starting September 2025. This study aims to emphasize the necessity of expanding HPV vaccination for males in Asia, based on global comparisons and the rationale for male vaccination.
1. History of HPV and HPV Vaccination
In the 1970s, HPV infection was first identified as a cause of female genital malignancies. In 1985, HPV DNA was detected in head and neck cancer tissues, and in 1995, HPV types 16 and 18 were officially classified as carcinogenic for genital cancers. The first HPV vaccine was developed in 2006, and in 2007, HPV-16 was acknowledged as a carcinogen for head and neck cancers. As of July 2025, 37 out of 38 OECD countries (excluding Türkiye) have implemented national vaccination programs. Japan and Korea currently only provide government-supported vaccination for females. In Asia, Mongolia, Bhutan, UAE, Qatar, and Kuwait offer vaccination for both sexes, with Taiwan including males starting in September 2025.
2. Global Status of HPV-Related Cancers
To reduce the incidence of cervical cancer to fewer than 4 cases per 100,000 women by 2030, the WHO has launched the "A World Without Cervical Cancer" initiative, targeting 90% vaccination coverage, 70% screening uptake, and 90% treatment rates. Globally, 87–96% of cervical cancers are HPV-related, with 92% in Asia alone. Additionally, head and neck cancers—the fifth most common cancer—are associated with HPV in 20–40% of cases. Penile cancer is linked to HPV in up to 90% of HGSIL cases and approximately 33% of invasive penile cancers. In total, HPV is associated with over 730,000 cancers worldwide, representing over 5% of all malignancies.
3. Rationale for HPV Vaccination in Males
HPV vaccination in males is often underprioritized, as the burden of prevention is traditionally placed on females. Unlike cervical cancer in females, there is no organized screening program for HPV-related non-cervical cancers in men, limiting secondary prevention benefits. Men also show lower awareness of HPV-related diseases, increasing their vulnerability to infection. Due to insufficient vaccine coverage, populations such as MSM and unvaccinated females remain inadequately protected despite herd immunity. Males act as a significant reservoir of HPV. Transmission from female to male occurs at a rate of 5.6 per 100 person-months, while male-to-female transmission is also substantial at 3.5. HPV-infected sperm demonstrates reduced motility and increased DNA fragmentation, potentially affecting fertility. In the U.S., the incidence of HPV-related oropharyngeal cancer in men has surpassed that of cervical cancer in women since the mid-2010s.
4. HPV Vaccination for Males in Asia
Asia is home to approximately 60% of the global population. However, the two most populous countries—China and India—do not include HPV vaccination in their national immunization programs. Among the Asian countries offering vaccination, only Mongolia, Bhutan, UAE, Qatar, Kuwait, and now Taiwan (from September 2025) provide GNV. There is significant variability in vaccination coverage across nations. According to GLOBOCAN data, 58% of global cervical cancer cases—around 352,000 new diagnoses—occur in Asia. Given Asia’s population size and disease burden, expanding HPV vaccination programs, particularly for males, is a critical public health priority.
5. Recommendations
To prevent HPV-related diseases—including cervical cancer, oropharyngeal cancer, and benign HPV-related conditions—HPV vaccination is recommended for both males and females aged 9–26.
Individuals aged 9–14 should receive two doses at 0 and 6 months; those aged 15–26 should receive three doses at 0, 1, and 6 months.
The optimal age for vaccination is 11–12 years.
Women aged 27 and above may receive the vaccine based on individual clinical decision-making.
6. Conclusion
HPV affects both sexes, contributing significantly to disease burden in males through cancers and anogenital warts. The lack of organized screening for HPV-related diseases in men makes gender-neutral vaccination (GNV) a fair and effective public health strategy. GNV may also accelerate cervical cancer elimination and increase program resilience against future disruptions. In particular, the high burden of HPV-related diseases in Asia underscores the urgency and importance of expanding vaccination coverage across the region.
-
Koichiro WadaJapan
Speaker
Antimicrobial Resistance on Neisseria Gonorrhoeae and Mycoplasma GenitaliumSexually transmitted diseases, in which Neisseria gonorrhoeae and Mycoplasma genitalium are the pathogenic microorganisms, have become a social problem also in Japan. Drug resistance has been increasing, especially among penicillins, macrolides, and fluoroquinolones in Neisseria gonorrhoeae. Mycoplasma genitalium was originally not highly susceptible to tetracyclines, but has recently become resistant to macrolides and fluoroquinolones. N. gonorrhea can be treated with a 1g single-dose of ceftriaxone, but urethritis caused by M. genitalium sometimes requires sequential/combination therapy, and many cases are difficult to treat. In my presentation, I would like to discuss diagnosis and treatment, especially drug resistance in Japan.
-
TICC - 2F 201BC
|
Kidney Transplant
-
Cheng-Kuang YangTaiwan
Moderator
Robotic Radical Prostatectomy: Trying to Fit the Right Surgery to the Right PatientDefinitive treatment for localized prostate cancer included radical prostatectomy and radiation. Successful criteria of radical prostatectomy have to meet oncology control, not persistent PSA after surgery without salvage therapy. MRI imaging stage and PSA density are predictors for short‐term BCR after prostatectomy. NCCN‐defined high‐risk patients with a high initial PSA 28 density, imaging stage (T3aN0M0 and T3bN0M0), and 29 pathologic stage (any N1) had a higher risk of BCR when 30 compared with other patients with undetectable PSA, while 31 those with pathologic stage (T3bN0M0 or any N1) displayed 32 a higher risk of postoperatively detectable PSA. These find‐ 33 ings may help urologists to identify patients for whom active 34 therapeutic protocols are necessary.
-
Alvin WeeUnited States
Speaker
How to Build Up a Strong Kidney Transplant Program with Continuing Growth?Transplantation is one of the most complex, highly regulated, multidisciplinary fields in medicine, requiring the coordination and dedication of a highly skilled and collaborative team.
At this conference, we’re honored to share our journey—highlighting the challenges, milestones, and strategic innovations that have shaped our transplant program. Through intentional planning, data-driven practices, and a strong team culture, we’ve grown to become the leading transplant center in the nation, recognized for both volume and quality outcomes.
Our hope is that by sharing our experience, we can contribute valuable insights to the transplant community and support others in advancing excellence in patient care.
Robotic Kidney Transplantation: The Way to Go?!The utilization of robotics in urologic surgery continues to grow, offering enhanced precision, improved outcomes, and faster recovery times. In the field of kidney transplantation, robotic-assisted techniques are now gaining significant momentum. The Cleveland Clinic Main Campus has emerged as the largest single center performing robotic-assisted kidney transplants annually—not only in the United States but also worldwide.
With this unparalleled experience, we are well positioned to share key advantages we have observed over traditional open surgical methods. As robotic technology continues to evolve, our experience reinforces its growing role in transforming the field of kidney transplantation and improving patient outcomes.
-
Ho-Yee TiongSingapore
Speaker
Living kidney donation with AI - Augmented or ArtificialAt the National University Hospital, we have utilized AI to try improving our pre-operative and peri-operative management of our patients for donor nephrectomy. This presentation shares the benefit of the learning experience of using AI through a standardized procedure like donor nephrectomy.
-
Brian K. LeeUnited States
Speaker
Genetic Testing in the Evaluation of Recipient Candidates and Living Kidney DonorWith the advent of more affordable next generation sequencing with ever faster turnaround times, precision medicine has taken on a more prominent role in clinical practice. This has meant that when determining the most appropriate course of action when evaluating potential kidney transplant recipients, genetic ascertainment of the underlying cause of their ESKD/CKD has become an increasingly indispensable tool. At the same time, related living kidney donors, especially those who are young, and who may not have any manifestations of renal symptoms can now be genetically tested to reassure transplant professionals and donors and their families that they are unlikely to harbor a hereditary condition that could jeopardize their future renal function. And yet the interpretation of genetic testing results is not part of the regular nephrology/transplant curriculum, and many centers do not have readily accessible medical geneticists or genetic counselors at their disposal, making the appropriate triaging of recipient and donor candidates alike somewhat of a black box. Through this session, we hope to elucidate the tough decisions and triumphs that comes with recognizing both the powers and the limitations of using genetic tests in transplant recipient and donor evaluations. Non-Invasive Immune MonitoringThe success of kidney transplantation is dependent on the close monitoring of kidney function and the net immune status of the host recipient. Traditional biomarkers such as serum creatinine are unreliable at best, often lagging behind histologic evidence of anti-graft activity when protocol biopsies are performed which could jeopardize opportunities for clinicians to intervene timely. Surveillance renal allograft biopsies have been employed in an attempt to match clinical outcomes with histologic findings, but this invasive procedure could lead to bleeding complications and is time- and labor intensive. Better immune monitoring has recently become more widely adopted in transplant practice, and its introduction could allow closer follow-up of the recipient and shed light on the state of immune milieu.
-
-
TICC - 2F 201DE
|
-
Hammad Ather Pakistan
Speaker
Current Evidence Supporting Adjuvant and Neo-Adjuvant TreatmentThe Upper Tract Urothelial Cancer (UTUC) is increasingly being considered as a genetic disorder. Following RNU, the IHC can detect a deficiency in mismatch repair proteins or microsatellite instability (MSI) using PCR. In the presence of MSI, it is necessary to undergo germline testing. High-grade UTUC is an aggressive cancer and is often associated with micrometastases, resulting in early recurrence and development of metastases. Risk classification and recognising more aggressive cancers in whom adjuvant or even neoadjuvant chemotherapy may be of benefit. One of the most crucial steps in considering patients for chemotherapy is the platinum eligibility, renal function (<30ml/min), functional status (ECOG >2) and comorbidities >2 grade are considered ineligible. There is good-quality evidence of improved survival for adjuvant chemotherapy in eligible patients following RNU for pT2–T4 and/or pN+ disease. The 2025 EAU guidelines recommend discussing adjuvant nivolumab with PD-L1-positive patients unfit for, or who declined, platinum-based adjuvant chemotherapy for ≥ pT3 and/or pN+ disease after previous RNU alone or ≥ypT2 and/or ypN+ disease after previous neoadjuvant chemotherapy, followed by RNU. However, the evidence supporting this recommendation is weak. Single intravesical chemotherapy is strongly recommended. There is currently no level 1 evidence supporting neo-adjuvant chemotherapy; however, non-randomised series have shown a decreased incidence of positive surgical margins, recurrence, and improved survival over RNU alone.Avoiding Complication in Orthotopic NeobladderIn most large series from Europe, approximately 1-2 of every 10 patients undergoing radical cystectomy have an orthotopic neobladder (ONB). Data is supporting ONB in terms of quality of life, cosmetics, and improved patient satisfaction. Early and late morbidity in up to 22% of patients is reported. The terminal ileum is the GI segment most often used for orthotopic bladder substitution. With ileo-ureteral anastomoses, there is UUT reflux, and renal functional deterioration is a concern. Various forms of UUT reflux protection, including a simple isoperistaltic tunnel, ileal intussusception, tapered ileal prolongation implanted subserosally, and direct (sub)mucosal or subserosal ureteral implantation, have been described. Superiority of one over the other is not proven. Urethral recurrence is a significant concern; therefore, patient selection must be optimal. Short-term complications are related to the GI tract, including atelectasis and metabolic acidosis. They are all preventable with standardised post-operative measures. The ERAS protocol is particularly useful in avoiding short-term complications and decreasing postoperative hospital stay, among other benefits. The key to success in preventing complications is meticulous patient selection and the implementation of preemptive measures to avoid common complications.Prostate Biopsy Technique: Current EvidenceOptimal prostate biopsy is critical in risk-stratifying patients for appropriate patient care. The traditional TRUS-guided biopsy is associated with UTI sepsis and other infectious complications. Recently, the use of the transperineal route has been advocated for the diagnosis of prostate cancer. Biopsy is either systematic or targeted. There is evidence supporting the notion that MRI-targeted biopsy without systematic biopsy significantly reduces the over-diagnosis of low-risk disease, compared to systematic biopsy. This seems true even when systematic biopsies are indicated after risk stratification with the Rotterdam Prostate Cancer Risk Calculator. EAU recommends performing prostate biopsy using the transperineal approach due to the low risk of infectious complications and better antibiotic stewardship. They also recommend using either target prophylaxis based on rectal swab or stool culture, or augmented prophylaxis (two or more different classes of antibiotics), for transrectal biopsy.
-
Vinod K.VIndia
Moderator
Testosterone Therapy: Implications for Cardiovascular Health Sexual Function Preservation in MIS for BPH
-
-
-
-
M. SivashankarSri Lanka
Speaker
Management of NMIBC during BCG Shortage EraDuring periods of Bacillus Calmette–Guérin (BCG) shortage, management of non muscle invasive bladder cancer (NMIBC) must be guided by risk stratification and resource optimization. Recent evidence supports reduced dosing (one third to half) rather than abbreviated schedules, with induction prioritized for high risk and carcinoma in situ cases. Alternative intravesical agents—mitomycin C (especially with chemohyperthermia or EMDA), gemcitabine, epirubicin, or sequential gemcitabine/docetaxel—are recommended when BCG is unavailable. In cases of incomplete BCG followed by chemotherapy, outcomes may be superior to chemotherapy alone. For high risk patients, upfront radical cystectomy should be considered when BCG is wholly unavailable. Future trials and supply diversification remain vital.
-
Athanasios PapatsorisGreece
Speaker
BCG Refractory Cancer: Current Status of Intravesical TreatmentRecommendations in Laser Use for the Treatment of Upper Tract Urothelial Carcinoma
-
-
Rajeev TPIndia
Moderator
Newer Advances in the Endourological Management of Stones – Have We Reached the Zenith
-
-
-
Hammad Ather Pakistan
Speaker
Current Evidence Supporting Adjuvant and Neo-Adjuvant TreatmentThe Upper Tract Urothelial Cancer (UTUC) is increasingly being considered as a genetic disorder. Following RNU, the IHC can detect a deficiency in mismatch repair proteins or microsatellite instability (MSI) using PCR. In the presence of MSI, it is necessary to undergo germline testing. High-grade UTUC is an aggressive cancer and is often associated with micrometastases, resulting in early recurrence and development of metastases. Risk classification and recognising more aggressive cancers in whom adjuvant or even neoadjuvant chemotherapy may be of benefit. One of the most crucial steps in considering patients for chemotherapy is the platinum eligibility, renal function (<30ml/min), functional status (ECOG >2) and comorbidities >2 grade are considered ineligible. There is good-quality evidence of improved survival for adjuvant chemotherapy in eligible patients following RNU for pT2–T4 and/or pN+ disease. The 2025 EAU guidelines recommend discussing adjuvant nivolumab with PD-L1-positive patients unfit for, or who declined, platinum-based adjuvant chemotherapy for ≥ pT3 and/or pN+ disease after previous RNU alone or ≥ypT2 and/or ypN+ disease after previous neoadjuvant chemotherapy, followed by RNU. However, the evidence supporting this recommendation is weak. Single intravesical chemotherapy is strongly recommended. There is currently no level 1 evidence supporting neo-adjuvant chemotherapy; however, non-randomised series have shown a decreased incidence of positive surgical margins, recurrence, and improved survival over RNU alone.Avoiding Complication in Orthotopic NeobladderIn most large series from Europe, approximately 1-2 of every 10 patients undergoing radical cystectomy have an orthotopic neobladder (ONB). Data is supporting ONB in terms of quality of life, cosmetics, and improved patient satisfaction. Early and late morbidity in up to 22% of patients is reported. The terminal ileum is the GI segment most often used for orthotopic bladder substitution. With ileo-ureteral anastomoses, there is UUT reflux, and renal functional deterioration is a concern. Various forms of UUT reflux protection, including a simple isoperistaltic tunnel, ileal intussusception, tapered ileal prolongation implanted subserosally, and direct (sub)mucosal or subserosal ureteral implantation, have been described. Superiority of one over the other is not proven. Urethral recurrence is a significant concern; therefore, patient selection must be optimal. Short-term complications are related to the GI tract, including atelectasis and metabolic acidosis. They are all preventable with standardised post-operative measures. The ERAS protocol is particularly useful in avoiding short-term complications and decreasing postoperative hospital stay, among other benefits. The key to success in preventing complications is meticulous patient selection and the implementation of preemptive measures to avoid common complications.Prostate Biopsy Technique: Current EvidenceOptimal prostate biopsy is critical in risk-stratifying patients for appropriate patient care. The traditional TRUS-guided biopsy is associated with UTI sepsis and other infectious complications. Recently, the use of the transperineal route has been advocated for the diagnosis of prostate cancer. Biopsy is either systematic or targeted. There is evidence supporting the notion that MRI-targeted biopsy without systematic biopsy significantly reduces the over-diagnosis of low-risk disease, compared to systematic biopsy. This seems true even when systematic biopsies are indicated after risk stratification with the Rotterdam Prostate Cancer Risk Calculator. EAU recommends performing prostate biopsy using the transperineal approach due to the low risk of infectious complications and better antibiotic stewardship. They also recommend using either target prophylaxis based on rectal swab or stool culture, or augmented prophylaxis (two or more different classes of antibiotics), for transrectal biopsy.
-
-
-
TICC - 1F 101D
|
Exploring Urology Service Challenges in ASEAN
-
Noor Ashani Md YusoffMalaysia
Moderator
Technical Pearls: Node Dissection in Robotic CystectomyHighlight and Limitation in Urology Service in MalaysiaRobotic Pelvic LN Dissection: A critical Component of Bladder Cancer Surgery
-
Noor Ashani Md YusoffMalaysia
Speaker
Technical Pearls: Node Dissection in Robotic CystectomyHighlight and Limitation in Urology Service in MalaysiaRobotic Pelvic LN Dissection: A critical Component of Bladder Cancer Surgery
-
-
-
Ferry SafriadiIndonesia
Speaker
Highlights and Limitations in Urology Service in Indonesia
Urological services in Indonesia have made substantial progress over the past decades, yet remain challenged by disparities in access, distribution of specialists, and healthcare infrastructure. Highlighting the strengths, Indonesia has seen a growth in the number of trained urologists, expansion of academic urology programs, and increasing adoption of minimally invasive surgical techniques in tertiary hospitals. Additionally, collaboration among national professional associations has promoted standardized clinical guidelines and continuing medical education. However, significant limitations persist. The geographical complexity of the Indonesian archipelago contributes to unequal access to urological care, particularly in remote and rural regions where specialist services are scarce. Limited availability of advanced diagnostic and therapeutic equipment in secondary healthcare centers further hinders timely and optimal management of urological diseases. Health financing constraints, particularly in the context of the national health insurance system (JKN), also impact the sustainability and quality of services. Moreover, research productivity and data-driven policy development in urology remain limited, affecting national efforts to address the burden of urological conditions such as prostate cancer, urolithiasis, and chronic kidney disease. Bridging these gaps requires a coordinated national strategy that includes workforce redistribution, infrastructure investment, telemedicine integration, and strengthened academic research networks. This abstract underscores both the achievements and ongoing challenges in Indonesia’s urology services, serving as a basis for future policy reform and capacity building.
-
Sotheavy VongCambodia
Speaker
Uro-Laparoscopic Activities in Cambodia at Kantha Bopha Children’s Hospital since 2018Background:
This is one of the largest series of laparoscopy reported in children. Laparoscopy also call minimally invasive procedure, bandied surgery or keyhole surgery is a modern surgical technique in neonates, children and adult. Laparoscopic surgery includes operations within the abdominal or pelvic cavities and in urology to perform surgery on the kidneys, bladder and other urinary tract organs.
There are a number of advantages to the patient with laparoscopic surgery versus an exploratory laparotomy. These include less pain due to smaller incision, reduced hemorrhaging, shorter hospital stays and faster recovery time.
The key element is the use of a uro-laparoscope, along fiber optic cable system that allows viewing of the affected area by snaking the cable from a more distant but more easily accessible location.
Purpose:
This study is to carried out surgical techniques, to investigate the feasibility and outcome of URO-LAPAROSCOPIC and to evaluate the postoperative results at various ages. The management should aim to reduce pain, hemorrhaging and shorter recovery time with a minimum of complications and an improvement of life quality. To clarify the roles of various treatment strategies for surgery we reviewed our experience at Kantha Bopha Children’s Hospitals, Phnom Penh, Cambodia.
Materials & Methods:
We are analyzed children diagnosed as endoscopic between the periods of 2018-2024 who presented to our hospital. 2366 children were diagnosed to have problem in Thoracic, Urology and Visceral who underwent the surgical managements were investigated at Kantha Bopha Children Hospital IV, Phnom Penh, Cambodia, during the period of 7 years between 1st January 2018 to 31st Decembre 2024.
Results:
The outcome of all our patients after surgery was in good results with a nice comfortable lifestyle postoperative. The duration of hospital stays and recovery time is faster than open surgery, from 7-10 days to 2-4 days. The median age at presentation was 7 years, with range of 1month to 15year-old. Male children constituted 1538 cases (65%) and Female 828 cases (35%). There are 12 cases (0.5%) of laparoscopic surgery that had complications postoperative.
The 1107 cases of Laparoscopic surgery were includes: pyeloplasty (Anderson-Hynes) in pelvic ureteric junction obstruction (PUJO) (98 cases), Heminephrectomy (28 cases), Nephrectomy (12 cases), Pyelolithotomy, Ureterolithotomy, Appendicitis, Peritonitis, Choledochal cyst, Gastrostomy (bezoars), Biopsy, Ovarian cyst or teratoma, Lung cystic emphysema. Moreover, in endourology surgery, 1259 cases with in Posterior urethral valve (56 cases), Ureterocele (41 cases) and Meatus ureteral stenosis (145 cases).
Conclusion:
Technological advancements have produced smaller endoscopic instruments with higher quality imaging that allow endoscopic surgeons to perform precise dissection with minimal bleeding to treat the patients in order to achieve the best outcome with more comfortable.
Therefore, we are trying our best on the endoscopy procedures in our country to improve the technical and the quality postoperative lifestyle to all the children.
Keywords: Advantages of Uro-laparoscopy, Anderson-Hynes’s procedure (PUJO), Posterior urethral valve
-
Phone MyintMyanmar
Speaker
Enhancement of Endourological Services in MyanmarMyanmar urological practice has been conducting since 1960s as a branch of surgical faculty and separate urology department was established in 1980s at Yangon General Hospital, a teaching hospital under university of medicine 1, Myanmar. Endourology procedures were started afterwards including Cystoscopic procedures (TUR, endoscopic stone crushing and etc:). PCNL and semirigid ureteroscopic procedures were established in early 1990s and were expanding till 2020s. Flexible ureteroscopic procedures were practiced since late 2010s.
After a political turmoil in 2021, some Human Resources in urology training pipeline were diverted and local resident training programs were disrupted.
Open urological procedures were routinely conducted but Endourology practices were severely affected in district area as a result of deficient Human Resources and logistical facilities.
Now, we are trying to push up the Endourology practice in secondary hospitals.
-
-
TICC - 3F South Lounge
|
|
12:00
13:00
|
Mastering Suction Ureteroscopy: How the Right Laser and Scope Combination Makes the Difference
-
-
-
Cheng-Chia LinTaiwan
Moderator
DISS plus FANS used in RIRSNew technologies and techniques are constantly emerging, but the most important part of our discussions is how to use them most effectively. Through this surgical demonstration, we hope to share the procedure and our experience with everyone.健保各領域審查共識及討論－結石
Vineet GauharSingapore
Speaker
Experimental and Real World Take Away Messages on DISSSuction in Renal Stone Treatment: DISS, FANS or Combined Procedure?Need of Future EndourologyChoosing the Correct Laser and Flex Scope Combination in Suction Ureteroscopy Can Be the Deal Breaker
TICC - 3F Banquet Hall
|
Integrating Radioligand Therapy into mCRPC Clinical Practice: From Taiwan and Japan Experience
TICC - 2F 201BC
|
Semi-Live Surgery- ECIRS
TICC - 2F 201DE
|
Time to Shift: From Medication Reliance to Minimally Invasive BPH Solutions
-
William J. HuangTaiwan
Moderator
Male Infertility: Challenges and Opportunities in AsiaMale infertility contributes to nearly 50% of all infertility cases, with an increasing burden observed across Asia. In parallel, a dramatic decline in birth rates has emerged in several Asian countries—including South Korea, Japan, Taiwan, and Singapore—reaching historically low total fertility rates (TFRs) of under 1.0. While multifactorial in nature, this demographic crisis underscores the urgent need to address all aspects of reproductive health, including the often-overlooked role of male infertility. Epidemiological data reveal significant regional disparities in the prevalence, diagnosis, and treatment of male infertility. Cultural stigma, limited andrology training, fragmented referral systems, and inadequate coverage of assisted reproductive technologies (ART) have impeded timely diagnosis and intervention. Environmental exposures, endocrine-disrupting chemicals, occupational heat, and increased paternal age have all been linked to declining semen quality, as evidenced by longitudinal studies showing decreased sperm concentration and motility in several urban centers across Asia. Current diagnostic tools—including semen analysis, hormone profiling, genetic testing (e.g., Y-chromosome microdeletion, karyotyping), and imaging—enable better etiological categorization. Microsurgical sperm retrieval techniques such as mTESE have provided new hope for patients with non-obstructive azoospermia, while ICSI and sperm cryopreservation have become increasingly utilized where available. Nevertheless, access remains inconsistent, particularly outside metropolitan regions. Recent integration of AI-based systems for semen evaluation, patient triage, and digital counseling offers promising strategies to improve care delivery, especially in under-resourced settings. However, data privacy, regulatory standards, and user trust continue to pose barriers to widespread implementation. Opportunities for systemic improvement include the development of regional male infertility registries, integration of andrology into national reproductive health frameworks, expansion of insurance coverage for fertility services, and public awareness campaigns to destigmatize male infertility. In light of Asia’s fertility decline, repositioning male reproductive health as a public health and demographic priority is essential for sustainable population policy and long-term healthcare planning.
The Peri-Operative Care of MIST For Prostate HyperplasiaMinimally invasive surgical therapies (MIST), particularly UroLift and Rezūm, have transformed the treatment landscape for benign prostatic hyperplasia (BPH), offering effective symptom relief with reduced morbidity and preservation of sexual function. However, optimal outcomes depend not only on procedural execution, but also on well-structured peri-operative care protocols encompassing pre-, intra-, and post-operative management. Pre-operative evaluation includes comprehensive assessment of prostate anatomy—especially size, shape, and presence of median lobe—via imaging (TRUS or cystoscopy) to determine candidacy. Careful patient selection is essential: UroLift is typically suited for prostates <80 cc without obstructive median lobes, while Rezūm accommodates broader anatomical variability but may have delayed symptom resolution. Baseline symptom scores (e.g., IPSS), uroflowmetry, and post-void residual volume establish functional benchmarks and guide patient counseling. Anesthesia planning must consider procedural setting and patient comorbidities. UroLift can often be performed under local anesthesia with light sedation, whereas Rezūm may require short general anesthesia or deeper sedation due to thermal discomfort. Appropriate selection reduces intraoperative stress and facilitates same-day discharge. Intraoperative care focuses on minimizing trauma and ensuring device precision. UroLift requires accurate deployment of implants to maintain lateral lobe retraction without compromising sphincter integrity. In Rezūm, the number and duration of vapor injections must be titrated based on lobe size and configuration to balance efficacy and tissue inflammation. Real-time visualization and standardized protocols reduce variability and improve safety. Post-operative management involves anticipating and controlling transient irritative symptoms, such as dysuria, urgency, and hematuria. Alpha-blockers and anti-inflammatory medications are commonly used for 3–7 days post-procedure. Catheterization strategies differ by technique: UroLift may avoid catheter use entirely, whereas Rezūm often requires 7-14 days of catheter drainage due to anticipated edema. Monitoring for urinary retention, UTI, or clot obstruction is critical during the early recovery phase. Follow-up care typically occurs at 2–4 weeks and includes reassessment of voiding function, symptom scores, and patient satisfaction. Reinforcement of realistic expectations is especially important with Rezūm, which may take 4–6 weeks to achieve peak efficacy. Longitudinal studies indicate sustained symptom relief and low retreatment rates when peri-operative care is standardized and patient education is emphasized. Adverse event profiles differ between techniques: UroLift is associated with less dysuria but higher retreatment rates in large prostates, while Rezūm presents higher rates of transient discomfort but favorable durability. Structured peri-operative care pathways—including patient education, standardized medication protocols, and clear complication management plans—enhance recovery, minimize adverse events, and improve overall clinical success.
Chi-Fai NgHong Kong, China
Speaker
Novel Robotic Surgery PlatformsOver the past decades, robotic surgery has become an essential approach in urological care. The recent blooming of different robotic platforms, in particular in Asian countries, has helped popularize robotic surgery in less developed countries. The introduction of robotic technology in endoluminal surgery has also helped to open up opportunities to further improve endourology. In the future, the incorporation of AI in robotic systems will help upgrade the standard of care in urology.
TICC - 2F 201AF
|
Collaborative Care: Mastering Techniques and Cardiovascular Considerations
-
-
Diego DegiovanniArgentina
Speaker
The Art of Care: Techniques to Foster Trust and Empower Patients from a Doctor’s Perspective (Malaysia and Argentina)
-
-
-
-
TICC - 1F 101A
|
|
12:00
13:00
|
Precision Over Size: The Era of Ultra-Thin RIRS
-
Steffi YuenHong Kong, China
Moderator
The Power of Powerbend in Management of Lower Pole and Complex StonesThe management of lower pole stones (LPS) and complex renal calculi remains one of the most challenging aspects of contemporary urolithiasis treatment, with the deflection capability of flexible ureteroscopes serving as the critical determinant of surgical success. Modern flexible ureteroscopes achieve impressive bidirectional deflection angles of 270° or even more, representing a significant advancement from earlier generation instruments. However, this “working deflection” capacity becomes substantially compromised when therapeutic instruments, such as laser fibers or stone baskets, are inserted through the working channel.
The anatomical challenges of lower pole access, particularly steep infundibulopelvic angles, necessitate prolonged maximal deflection during lithotrispy that significantly increases the risk of ureteroscope damage and surgeon fatigability. Deflection deterioration is also directly proportional to instrument usage, with newer single-use scopes coming to the rescue.
The introduction of flexible and navigable suction access sheaths (FANS) has revolutionized lower pole stone management allowing direct access to performing lithotriopsy and stone fragments retrieval, reducing the need for stone basket in stone relocation and fragment retrieval. Recent multicenter studies demonstrate comparable stone-free rates (<2mm) between lower pole and non-lower pole locations (96.6% vs 98.4%) when using FANS, with minimal complications and low reintervention rates. With current technological advancements, combined with improved surgical techniques and the strategic choice of single-use ureteroscopes with good deflection power, one can significantly achieve high stone-free rates with low infectious complications and reinterventions with FANS flexible ureteroscopy in the treatment of complex lower pole stones.
FANs in Endourology: Finding the Best Combination with Lasers and Scopes for Optimal Outcomes
Steffi YuenHong Kong, China
Speaker
The Power of Powerbend in Management of Lower Pole and Complex StonesThe management of lower pole stones (LPS) and complex renal calculi remains one of the most challenging aspects of contemporary urolithiasis treatment, with the deflection capability of flexible ureteroscopes serving as the critical determinant of surgical success. Modern flexible ureteroscopes achieve impressive bidirectional deflection angles of 270° or even more, representing a significant advancement from earlier generation instruments. However, this “working deflection” capacity becomes substantially compromised when therapeutic instruments, such as laser fibers or stone baskets, are inserted through the working channel.
The anatomical challenges of lower pole access, particularly steep infundibulopelvic angles, necessitate prolonged maximal deflection during lithotrispy that significantly increases the risk of ureteroscope damage and surgeon fatigability. Deflection deterioration is also directly proportional to instrument usage, with newer single-use scopes coming to the rescue.
The introduction of flexible and navigable suction access sheaths (FANS) has revolutionized lower pole stone management allowing direct access to performing lithotriopsy and stone fragments retrieval, reducing the need for stone basket in stone relocation and fragment retrieval. Recent multicenter studies demonstrate comparable stone-free rates (<2mm) between lower pole and non-lower pole locations (96.6% vs 98.4%) when using FANS, with minimal complications and low reintervention rates. With current technological advancements, combined with improved surgical techniques and the strategic choice of single-use ureteroscopes with good deflection power, one can significantly achieve high stone-free rates with low infectious complications and reinterventions with FANS flexible ureteroscopy in the treatment of complex lower pole stones.
FANs in Endourology: Finding the Best Combination with Lasers and Scopes for Optimal Outcomes
-
Steffi YuenHong Kong, China
Moderator
The Power of Powerbend in Management of Lower Pole and Complex StonesThe management of lower pole stones (LPS) and complex renal calculi remains one of the most challenging aspects of contemporary urolithiasis treatment, with the deflection capability of flexible ureteroscopes serving as the critical determinant of surgical success. Modern flexible ureteroscopes achieve impressive bidirectional deflection angles of 270° or even more, representing a significant advancement from earlier generation instruments. However, this “working deflection” capacity becomes substantially compromised when therapeutic instruments, such as laser fibers or stone baskets, are inserted through the working channel.
The anatomical challenges of lower pole access, particularly steep infundibulopelvic angles, necessitate prolonged maximal deflection during lithotrispy that significantly increases the risk of ureteroscope damage and surgeon fatigability. Deflection deterioration is also directly proportional to instrument usage, with newer single-use scopes coming to the rescue.
The introduction of flexible and navigable suction access sheaths (FANS) has revolutionized lower pole stone management allowing direct access to performing lithotriopsy and stone fragments retrieval, reducing the need for stone basket in stone relocation and fragment retrieval. Recent multicenter studies demonstrate comparable stone-free rates (<2mm) between lower pole and non-lower pole locations (96.6% vs 98.4%) when using FANS, with minimal complications and low reintervention rates. With current technological advancements, combined with improved surgical techniques and the strategic choice of single-use ureteroscopes with good deflection power, one can significantly achieve high stone-free rates with low infectious complications and reinterventions with FANS flexible ureteroscopy in the treatment of complex lower pole stones.
FANs in Endourology: Finding the Best Combination with Lasers and Scopes for Optimal Outcomes
-
Steffi YuenHong Kong, China
Moderator
The Power of Powerbend in Management of Lower Pole and Complex StonesThe management of lower pole stones (LPS) and complex renal calculi remains one of the most challenging aspects of contemporary urolithiasis treatment, with the deflection capability of flexible ureteroscopes serving as the critical determinant of surgical success. Modern flexible ureteroscopes achieve impressive bidirectional deflection angles of 270° or even more, representing a significant advancement from earlier generation instruments. However, this “working deflection” capacity becomes substantially compromised when therapeutic instruments, such as laser fibers or stone baskets, are inserted through the working channel.
The anatomical challenges of lower pole access, particularly steep infundibulopelvic angles, necessitate prolonged maximal deflection during lithotrispy that significantly increases the risk of ureteroscope damage and surgeon fatigability. Deflection deterioration is also directly proportional to instrument usage, with newer single-use scopes coming to the rescue.
The introduction of flexible and navigable suction access sheaths (FANS) has revolutionized lower pole stone management allowing direct access to performing lithotriopsy and stone fragments retrieval, reducing the need for stone basket in stone relocation and fragment retrieval. Recent multicenter studies demonstrate comparable stone-free rates (<2mm) between lower pole and non-lower pole locations (96.6% vs 98.4%) when using FANS, with minimal complications and low reintervention rates. With current technological advancements, combined with improved surgical techniques and the strategic choice of single-use ureteroscopes with good deflection power, one can significantly achieve high stone-free rates with low infectious complications and reinterventions with FANS flexible ureteroscopy in the treatment of complex lower pole stones.
FANs in Endourology: Finding the Best Combination with Lasers and Scopes for Optimal Outcomes
-
Steffi YuenHong Kong, China
Moderator
The Power of Powerbend in Management of Lower Pole and Complex StonesThe management of lower pole stones (LPS) and complex renal calculi remains one of the most challenging aspects of contemporary urolithiasis treatment, with the deflection capability of flexible ureteroscopes serving as the critical determinant of surgical success. Modern flexible ureteroscopes achieve impressive bidirectional deflection angles of 270° or even more, representing a significant advancement from earlier generation instruments. However, this “working deflection” capacity becomes substantially compromised when therapeutic instruments, such as laser fibers or stone baskets, are inserted through the working channel.
The anatomical challenges of lower pole access, particularly steep infundibulopelvic angles, necessitate prolonged maximal deflection during lithotrispy that significantly increases the risk of ureteroscope damage and surgeon fatigability. Deflection deterioration is also directly proportional to instrument usage, with newer single-use scopes coming to the rescue.
The introduction of flexible and navigable suction access sheaths (FANS) has revolutionized lower pole stone management allowing direct access to performing lithotriopsy and stone fragments retrieval, reducing the need for stone basket in stone relocation and fragment retrieval. Recent multicenter studies demonstrate comparable stone-free rates (<2mm) between lower pole and non-lower pole locations (96.6% vs 98.4%) when using FANS, with minimal complications and low reintervention rates. With current technological advancements, combined with improved surgical techniques and the strategic choice of single-use ureteroscopes with good deflection power, one can significantly achieve high stone-free rates with low infectious complications and reinterventions with FANS flexible ureteroscopy in the treatment of complex lower pole stones.
FANs in Endourology: Finding the Best Combination with Lasers and Scopes for Optimal Outcomes
-
TICC - 1F 101B
|
Optimising OAB Management to Advance Patient Outcomes
-
-
Advancing OAB Treatment Through the Years
-
Enhancing Patient-Centered OAB Care: Practical Insights and Approaches
-
Innovating the Future of OAB Care
-
TICC - 1F 101C
|
Optimising OAB Management to Advance Patient Outcomes
-
-
Advancing OAB Treatment Through The Years
-
Enhancing Patient-Centered OAB Care: Practical Insights and Approaches
-
Innovating The Future of OAB Care
-
TICC - 1F 101D
|
Advances and Clinical Applications in ESWL Symposium
TICC - 3F South Lounge
|
Solution for Complicated Renal Stone: from RIRS to Ultramini ECIRS
TWTC - 1F Exhibition Hall
|
|
13:30
15:00
|
-
John DavisUnited States
Speaker
Open Surgery Training: Is It Necessary in the Era of Robotics?Open surgery training in the era of robotics may or may not be a training environment that urology has control of, given worldwide access to robotic or at least laparoscopic techniques and strong patient preference. There may be some applications where a given experienced urologist can prefer open over minimally invasive surgery (MIS), such as radical cystectomy, or indications possibly outside of MIS feasibility such as large renal tumors with caval thrombus. Specific to training and expertise, there are 3 principle features of surgical skills desired: 1) knowing ideal exposure, 2) recognition of surgical planes, and 3) knowing anatomy before it can be seen. Although some trainees may only see MIS for certain indications, open surgery may expedite the process. There are no human studies identified on the topic, but a skills lab study was instructive (Farah, J Surgical Education 2023) showing that interns with open and MIS training performed higher comparing pre-intern to post intern bootcamp skills. The benefits of a solid training pathway including open experience are to move trainees towards the faster-to-progress part of the learning curve such that the attending can offer a safe training environment while moving the case along efficiently.The Future of Surgical Skills Evaluation: What Is on Your Wish List?Surgical skills training vary significantly by region with some systems putting trainees on a timed set of years, while others apprentice trainees until meeting a threshold for skills. Early training assessments were basic timed events with qualitative scores (subject to strong attending selection for success). Trainees should experience and/or study the key pitfalls to avoid and performance goals. Surgical simulation can be highly useful, but tend to improve only certain skills and not full case needs. Updated simulation moves from digital to hands on surgical models and may move the needle towards human experience. Training can be augmented with descriptors of surgical gestures and measuring which ones are most effective. The experience for the trainee is often depicted as an "autonomy gap" whereby the training desires to have case control, possibly before they are ready. Progression can be measured by descriptors of performance from assistance through full performance without coaching. The next frontier will be artificial intelligence guided measurement where specific performances can be characterized and diagnosed for success. My ultimate wishlist would be for methods to correlate skills to outcomes, optimized curricula, and a specific pathway to correct underperformance.Tips and Tricks in Challenging Cases of Robotic Radical ProstatectomyThere are many specific challenges with robotic radical prostatectomy (RARP) that can be described and illustrated--the most 5 common are 1) difficulty access, 2) obesity, 3) pubic arch interference, 4) anatomic challenges, and 5) reconstruction challenges. In this video sample, we demonstrate 2 challenges: obesity requiring a pelvic lymph node dissection and significant pelvic de-fatting to identify the proper surgical landmarks. Next a massive sized prostate that has had a partial transurethral resection--together presenting challenges with landmarks, a difficult bladder neck to diagnose, and final reconstruction challenges.
-
Vipul R. PatelUnited States
Speaker
Lessons from 20,000 Robotic Prostatectomies: A Global Expert’s PerspectiveTechnical Considerations for Large Prostates over 100gmsTelesurgery: The Future of Surgery
-
Simone CrivellaroUnited States
Speaker
Single-Port vs. Multi-Port Robotic Prostatectomy: Balancing Innovation, Precision, and OutcomesThe Application & Limitation of Urological SP SurgerySingle Port Retroperitoneal Partial NephrectomySingle Port Prostate Surgery
-
Ketan BadaniUnited States
Speaker
Expanding horizons: SP for complex RAPNThe Future of Urological Robotic SurgerySingle-Port Robotic Partial Nephrectomy for Multiple or Large Renal TumorsHow to Standardize Training by AI-Learning from The Best Practice of Urological Robotic SurgerySP Partial Nephrectomy
-
Wenjie ZhongAustralia
Speaker
Emergency Undocking in Robotic Urology Surgery - Preparedness, Protocols, and PracticeIntroduction:
Robotic surgery has revolutionized urologic procedures, offering precision and minimally invasive benefits. However, the complexity of the robotic interface introduces the rare but potentially catastrophic need for emergency undocking - a rapid disengagement of the robotic system in response to patient or technical emergencies.
Objective:
To review the current best practices, protocols, and preparedness strategies for emergency undocking during robotic urologic surgery, with a focus on multidisciplinary coordination, training, and outcome optimization.
Methods:
A structured review of the literature was conducted, including case reports, institutional protocols, and guideline recommendations from leading urological societies (AUA, EAU). In addition, procedural algorithms and simulation-based training approaches were analyzed to assess their impact on team performance and patient safety.
Results:
Emergency undocking occurs in fewer than 0.1% of robotic cases but is associated with high morbidity if delays occur. Key indications include sudden hemodynamic collapse, cardiac arrest, airway compromise, and robotic system malfunction. Simulation training has been shown to improve undocking times by up to 35%. Effective response hinges on predefined roles, verbal cues, and practiced protocols. Institutions with regular team drills report faster response times and better outcomes in high-acuity scenarios.
Conclusion:
Although infrequent, emergency undocking represents a critical moment in robotic surgery that demands rapid, coordinated team action. Implementing standardized protocols, reinforcing multidisciplinary simulations, and fostering a culture of readiness can significantly improve patient safety and surgical outcomes.
-
Yen-Chuan OuTaiwan
Speaker
ARUS–PRUS Partnership Ceremony: A New Chapter in Asia Robotic Urology CollaborationDear colleagues and friends,
It’s a great honor to witness the signing of this partnership between the Asian Robotic Urology Society (ARUS) and the Philippines Robotic Urology Society (PRUS).
This marks the beginning of a new chapter in regional collaboration—one that emphasizes shared training, joint research, and mutual support to advance robotic urology across Asia. PRUS brings energy, expertise, and vision to this partnership, and ARUS is proud to walk alongside you as we work toward higher standards and better outcomes for our patients. Let us move forward together—with unity, purpose, and innovation.
Congratulations to both ARUS and PRUS!Aquablation Revolutionizing BPH Treatment: A New Era of Minimally Invasive Therapy-Tungs' Taichung Metroharbor Hospital ExperienceIntroduction
Aquablation is a waterjet ablation therapy for benign prostatic hyperplasia (BPH) that has gained significant attention. While its efficacy, durability, and safety have been established across various prostate sizes (30–150 mL), local data on its efficacy, safety, and learning curve in Taiwan remain limited. Our team have been performed 85 cases between March 2024 and July 2025. This lecture presents the learning curve observed in the first 50 patients who underwent Aquablation for BPH, highlighting its role in revolutionizing BPH treatment.
Materials and Methods
We conducted a retrospective review of 50 consecutive patients who underwent Aquablation between March 2024 and February 2025, dividing them into two groups: Group I (first 25 cases) and Group II (subsequent 25 cases). Assessments included IPSS, QoL, uroflowmetry parameters (voiding volume, Qmax, Qmean, PVR), operative time, hemoglobin drop, Clavien-Dindo grade ≥2 complications, hospital stay, and urethral catheter duration.
Results
Patients in Group II were younger and had smaller prostates. Aquablation was successfully performed in all cases. IPSS, QoL, voiding volume, Qmax, and Qmean improved significantly and were sustained for three months, while PVR improved only in Group I. Operative time was significantly shorter in Group II, and hemoglobin drop was greater in Group I. Complication rates, hospital stay, and catheter duration were similar between groups.
Conclusions
Aquablation provided significant and immediate improvements in voiding parameters and symptoms, with sustained PVR benefits in larger prostates. Surgeon proficiency improved after 25 cases. Overall, Aquablation proved safe and effective, even in an unselected patient population. Aquablation represents a promising advancement that could transform the therapeutic landscape for BPH—particularly if costs are reduced.Experience of 100 Consecutive Hugo Robotic Radical ProstatectomiesIntroduction and background:
Dr. Ou’ surgical team of Tungs’ Taichung MetroHarbor Hospital performed the first Hugo robotic radical prostatectomy on May 9, 2023. In 2023, we published the results of the first series of 12 Hugo robotic radical prostatectomies performed. In 2024, we published a comparison of 30 Hugo robotic radical prostatectomies and 30 Da Vinci robotic radical prostatectomies. Professor Ou is the Hugo robotic arm instructor recognized by Medtronic. Many Southeast Asian doctors come to this Hospital to observe the surgery and learn.
Material and Methods:
We prospectively collected data for retrospective analysis and statistics from May 9, 2023 to April 30, 2025, performing 100 consecutive Hugo robotic radical prostatectomies. We compared the surgical results of 1-50 cases (group 1) and 51-100 cases (group 2). The data analyzed included basic information, age, risk of anesthesia, BMI , prostate-specific antigen, clinical stage, and Gleason score grade. The two groups were compared in terms of surgical difficulty, receipt of neoadjuvant hormonal therapy, obesity, prostate volume >70 g, prostate protrusion more than 1 cm into the bladder neck, previous transurethral resection of prostate, history of abdominal surgery, extensive pelvic lymphadenectomy, salvage radical prostatectomy, and time from biopsy to radical prostatectomy less than 6 weeks. The two groups were compared in terms of robotic console time, blood loss, blood transfusion rate, and surgical complications. We compared the two groups in terms of postoperative pathological staging and grade, the proportion of tumor, and the proportion of urinary control at one month and three months.
Results:
The study showed that the age of patients in the second group was slightly higher, but the statistical p value was 0.058, which did not reach statistical difference. The second group of patients had significantly higher rates of stage III, stage IV, lymph node and bone oligometastasis, with a p value of 0.021. The rate of neoadjuvant hormonal therapy received by the second group was 16 percent, which was statistically significant compared with 2 percent of the first group (p = 0.021). The rates of other surgical difficulty factors were the same between the two groups. The average blood loss of patients in the second group was 156 CC, which was significantly less than the 208 CC in the first group. The operation time and surgical complications were comparable between the two groups. The cancer volume of the second group of patients was significantly reduced compared with that of the first group (3.30±2.93 versus 5.09±5.24, p value=0.049). The reason was that more patients in the second group received neoadjuvant hormonal therapy, which significantly reduced the cancer. Both groups of patients had very good urinary control after surgery.
Conclusion:
We conclude that Hugo robotic radical prostatectomy is an effective and feasible method with extremely low complications and good recovery of urinary control function after surgery. After the experience of the first 50 operations, the surgeon will choose patients with higher difficulty, especially those receiving neoadjuvant hormone therapy, to perform the operation.Total Solution of Maintenance of Urinary and Sex Function during Robotic Radical ProstatectomyBackground:
Robotic-assisted radical prostatectomy (RARP) has become a preferred surgical approach for localized prostate cancer due to its minimally invasive nature and precision. However, the preservation of urinary continence and sexual function remains a significant postoperative challenge. Traditional outcomes have focused heavily on oncological safety. Yet, contemporary perspectives emphasize a more holistic view—embodied in the concept of the “Pentafecta,” which includes continence, potency, negative surgical margins, biochemical recurrence-free survival, and absence of perioperative complications.
Objective:
This presentation introduces a comprehensive and integrative approach aimed at maximizing functional outcomes—particularly urinary continence and erectile function—through a modified pubovesical complex-sparing RARP under regional hypothermia, supplemented with real-time nerve imaging, neurovascular preservation strategies, and biological enhancement techniques.
Methods:
We present data and experience from Tungs’ Taichung MetroHarbor Hospital (TTMHH), including a series of 3780 robotic procedures performed between December 2005 and July 2025. Among these, 100 cases were completed using the Hugo™ RAS system and 21 with the da Vinci SP™ platform. Our modified technique builds upon Dr. Richard Gaston’s pubovesical complex-sparing method, with the addition of localized hypothermia (24°C), near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG), and application of dehydrated human amnion/chorion membrane (dHACM). In selected cases, nerve grafting with Axogen® technology was applied.
Results:
Initial results indicate a significantly improved early return of continence (95% by 16 weeks) and promising erectile function recovery, particularly in patients who received adjunctive therapies such as phosphodiesterase inhibitors or vacuum erection devices. The precision afforded by robotic technology enabled preservation of
prostate capsular arteries and accessory pudendal arteries. Localized hypothermia contributed to reduced tissue edema, minimized neural trauma, and improved nerve recovery. The use of ICG-NIRF allowed real-time identification of critical vascular landmarks, enhancing nerve-sparing accuracy. Preliminary analysis suggests our technique is both feasible and reproducible.
Conclusion:
The modified pubovesical complex-sparing RARP under hypothermia, augmented with vascular imaging and biologic materials, offers a promising paradigm for functional preservation in prostate cancer surgery. This total solution approach not only protects neurovascular integrity but also accelerates recovery of continence and potency.
Continued accumulation of clinical cases and controlled comparative studies are warranted to further validate the efficacy and long-term benefits of these techniques.
Significance:
This strategy reflects a patient-centered evolution in robotic prostate surgery, merging surgical innovation with anatomical preservation and technological augmentation. It represents an epic collaboration of surgical precision, team-based care, and thoughtful application of biomedical advances to improve quality of life outcomes in prostate
cancer patients.Total Solution of Maintenance of Urinary and Sex Function during Robotic Radical Prostatectomy
TICC - 3F Plenary Hall
|
Effective Communication Conflict Resolution; Develop a Compelling Vision to Motivate Others
-
-
Eddie ChanHong Kong, China
Speaker
How to Escape Surgical ComplicationsSurgical complications can significantly impact patient outcomes and healthcare resources. This talk will focus on practical strategies to minimize complications in urologic surgery, tailored specifically for urology fellows. Real-life case examples will illustrate how thoughtful preparation and proactive communication can prevent or mitigate complications. Additionally, we will discuss structured approaches to managing complications when they arise, including communication with the patient and team, documentation, and timely intervention. Through real-life case examples, this session aims to enhance surgical judgment, promote patient safety, and build confidence in complication management.
Michael WongSingapore
Speaker
Introduction to Asia School of UrologyAsian School of Urology 2022-2026 – New initiatives
Dr Michael YC Wong
Principal Director of ASU 2022-2026
President Endourological Society and WCET 2026
Introduction
Asian School of Urology (ASU) officially started in 1999 with the appointment of her first director Prof Pichai Bunyaratavej from Thailand (1999-2002) Subsequent directors were Dato Dr Rohan Malek from Malaysia (2002-2006) Prof Foo Keong Tatt from Singapore (2006-2010) Prof Rainy Umbas from Indonesia (2010-2014 ) and Prof Shin Egawa from Japan ( 2014-2022 ).
One of the highlights of the ASU in the early days were the organization of several workshops outside of UAA congress by three active sub-specialty sections of UAA namely Asian society of Endourology (over 16 workshops held from 1998-2008), Asian Society of Female Urology and Asia-Pacific society of Uro-Oncology. Other subspecialty sections were subsequently introduced and have matured very well including Asian Society of UTI and STI, Asian-Pacific Society of Andrological and Reconstructive Urology Surgeons.
In the last 8 years, ASU has seen tremendous growth under the steady leadership of Prof Shin Egawa with introduction of UAA lecturers at national Meetings and further maturation of the subspecialty sections of UAA e.g., Conversion of Asian society of endourology to Asian Robotic Urological Society to reflect the growth and development of UAA. During the past 8 years, ASU-South-East Asia section has also managed to organize 15 physical workshops and 4 webinars outside of UAA congress.
The Growth Trajectory for the next 4 years 2022-2026
There are many areas where ASU can grow further. Bearing in mind our limited resources and our excellent relationships with the world urological leaders at this point in our history.
There are three areas which I will focus on. Please remember that ASU is always open to other new initiatives as we must stay relevant to our Asian urological community.
1. Lasting and strong Relationships
1.1 AUA. Over a dish of chili crab with AUA secretary general Gopal Badlani, we explored the common desire to elevate Asian Urology and strengthen UAA Family. This led to our first joint UAA-AUA residency course at UAA Singapore 2016. After successful completion, a MOU was signed at AUA 2017 with Richard Babayan, Manoj Monga, Allen Chiu and myself in attendance. The AURC at UAA Hong Kong under Prof Eddie Chan was the result of this signed MOU. We are extremely grateful for the generosity of AUA for this program. What may not be obvious is that Gopal Badlani, Manoj Monga, John Denstedt and I served as faculty and board directors at WCE. We will sign the extension MOU in 2023 for another three years.
1.2 EAU. We have a very successful UAA-EAU Youth program since UAA Thailand 2012. This has been the work of several UAA senior members. From 2023, we are exploring joint webinars with EAU to build on this relationship.
1.3 SIU and WCE. We will further explore options based on available resources and manpower. Joint Webinar are planned for early 2026
2. Education Platform for Asian Urology Residents
From 2023, we will continue to grow our relationship with BJUI. BJUI has developed a world class online learning platform with tremendous investments since 2013. This platform is called BJUI Knowledge. ASU will reach out to all Asian residents via their national urological association president and secretary to encourage every resident to sign up for a free access to more than 420 interactive 30-minute modules covering the whole urology syllabus suitable for learning, exit exams and recertification exams. I am personally involved in developing all modules under Endourology and urolithiasis Section and have been associate editor since May 2013. The modest aim is for at least 10 residents per country to sign up by UAA 2023. We will report progress at each UAA council meeting. Pls see attached information and if there are any questions pls email me personally at email@drmichaelwong.com
3. Re-Strategize Training cum fellowship sites for ASU.
3.1 In the past we have always talked about the possibility about training sites for UAA and ASU. It has always been a difficult task due to financial and multiple logistics issues.
3.2 What can we do that is possible? Let us consider two options in the next 4 years.
3.3 For the last 6 years a group of Asian urologists started AUGTEG to design and provide two-day surgical training which includes lectures as well as dry and wet lab to develop surgical skills. AUSTEG has direct access to physical training centres in Thailand, South Korea, and China.
ASU will work with AUGTEC to pool resources since we are the same people working on both sides e.g., Anthony Ng (chairman of AUSTEG) Michael Wong (vice chairman) Eddie Chan (treasurer). AUGTEG is registered in HK.
3.4 The second option is to recognise elected university or training Asian centres to allow an attachment for young urologist post residency in a flexible format. ASU will recognise officially these sites as endorsed by UAA. At UAA 2025 , several potential ASU/UAA fellowship sites directors will be presenting their programmes to kickstart this initiative
4. In conclusion, ASU will continue to grow and serve the Asian Urological Community. The above initiatives are only the beginning of a next chapter. Can you contribute your ideas and current available resources for this purpose? If you can, Pls email me personally at email@drmichaelwong.com
Which Position is the Best for PCNL in 2025?With tremendous advances in both technique and technology , the MIS approach to staghorn calculi has evolved significantly over the last 30 years.
It is timely to review all the landmark articles on patient positioning as this ultimately determines renal access which in turn plays a major role in stone free rates. We will gain much insight as we debate and attempt to answer the question of which position is best in 2026!
-
Hung-Jen WangTaiwan
Speaker
Technical Pearls: Nerve-SparingPreserving the neurovascular bundles (NVB) during robotic-assisted radical prostatectomy (RARP) is crucial for maintaining postoperative continence and sexual function, while still ensuring complete cancer removal. We will share "technical pearls" for nerve-sparing in RARP, emphasizing practical innovations that enhance surgical precision without compromising oncologic control.
Retrograde nerve-sparing involves a bottom-up (apex-to-base) dissection of the NVB using an athermal, gentle approach. This technique, adapted from open surgery, allows early identification and release of the nerves under direct vision. By minimizing traction and avoiding cautery near the NVB, it reduces inadvertent nerve injury and even lowers the risk of positive margins at the prostatic base. Clinically, adopting a retrograde approach (often with 30° lens “toggling”) has been linked to faster functional recovery of potency, contributing to potency rates approaching 90% at 1 year in fully nerve-sparing cases.
Parallel advances in augmented reality (AR) are providing real-time surgical navigation. AR technology superimposes 3D virtual models (e.g. from MRI) onto the operative field, enhancing visualization of patient-specific anatomy. Surgeons can pinpoint tumor location relative to the NVB, enabling selective, confidence-guided nerve preservation even in locally advanced disease. This approach helps modulate nerve-sparing extent on a case-by-case basis, maintaining oncologic safety (low positive surgical margin rates) while maximizing nerve preservation.
Finally, refined anatomical landmarks have emerged to guide nerve-sparing. A notable example is the identification of a consistent small arterial branch (“landmark artery”) at the NVB’s medial aspect. This vessel serves as a guide for partial nerve-sparing: dissecting just lateral to it yields an approximate 3 mm tissue margin from the prostatic capsule, sufficient to clear potential extracapsular extension while preserving the remaining nerve fibers. Such landmark-oriented dissection provides a reproducible framework for tailoring nerve-sparing to tumor risk, moving beyond the traditional “all-or-none” approach.
These advanced techniques and concepts are empowering robotic surgeons to achieve optimal outcomes. By integrating retrograde nerve-sparing, AR-assisted navigation, and anatomical landmark guidance, one can improve early continence recovery and postoperative sexual function for patients without sacrificing cancer control.
-
Michael WongSingapore
Speaker
Introduction to Asia School of UrologyAsian School of Urology 2022-2026 – New initiatives
Dr Michael YC Wong
Principal Director of ASU 2022-2026
President Endourological Society and WCET 2026
Introduction
Asian School of Urology (ASU) officially started in 1999 with the appointment of her first director Prof Pichai Bunyaratavej from Thailand (1999-2002) Subsequent directors were Dato Dr Rohan Malek from Malaysia (2002-2006) Prof Foo Keong Tatt from Singapore (2006-2010) Prof Rainy Umbas from Indonesia (2010-2014 ) and Prof Shin Egawa from Japan ( 2014-2022 ).
One of the highlights of the ASU in the early days were the organization of several workshops outside of UAA congress by three active sub-specialty sections of UAA namely Asian society of Endourology (over 16 workshops held from 1998-2008), Asian Society of Female Urology and Asia-Pacific society of Uro-Oncology. Other subspecialty sections were subsequently introduced and have matured very well including Asian Society of UTI and STI, Asian-Pacific Society of Andrological and Reconstructive Urology Surgeons.
In the last 8 years, ASU has seen tremendous growth under the steady leadership of Prof Shin Egawa with introduction of UAA lecturers at national Meetings and further maturation of the subspecialty sections of UAA e.g., Conversion of Asian society of endourology to Asian Robotic Urological Society to reflect the growth and development of UAA. During the past 8 years, ASU-South-East Asia section has also managed to organize 15 physical workshops and 4 webinars outside of UAA congress.
The Growth Trajectory for the next 4 years 2022-2026
There are many areas where ASU can grow further. Bearing in mind our limited resources and our excellent relationships with the world urological leaders at this point in our history.
There are three areas which I will focus on. Please remember that ASU is always open to other new initiatives as we must stay relevant to our Asian urological community.
1. Lasting and strong Relationships
1.1 AUA. Over a dish of chili crab with AUA secretary general Gopal Badlani, we explored the common desire to elevate Asian Urology and strengthen UAA Family. This led to our first joint UAA-AUA residency course at UAA Singapore 2016. After successful completion, a MOU was signed at AUA 2017 with Richard Babayan, Manoj Monga, Allen Chiu and myself in attendance. The AURC at UAA Hong Kong under Prof Eddie Chan was the result of this signed MOU. We are extremely grateful for the generosity of AUA for this program. What may not be obvious is that Gopal Badlani, Manoj Monga, John Denstedt and I served as faculty and board directors at WCE. We will sign the extension MOU in 2023 for another three years.
1.2 EAU. We have a very successful UAA-EAU Youth program since UAA Thailand 2012. This has been the work of several UAA senior members. From 2023, we are exploring joint webinars with EAU to build on this relationship.
1.3 SIU and WCE. We will further explore options based on available resources and manpower. Joint Webinar are planned for early 2026
2. Education Platform for Asian Urology Residents
From 2023, we will continue to grow our relationship with BJUI. BJUI has developed a world class online learning platform with tremendous investments since 2013. This platform is called BJUI Knowledge. ASU will reach out to all Asian residents via their national urological association president and secretary to encourage every resident to sign up for a free access to more than 420 interactive 30-minute modules covering the whole urology syllabus suitable for learning, exit exams and recertification exams. I am personally involved in developing all modules under Endourology and urolithiasis Section and have been associate editor since May 2013. The modest aim is for at least 10 residents per country to sign up by UAA 2023. We will report progress at each UAA council meeting. Pls see attached information and if there are any questions pls email me personally at email@drmichaelwong.com
3. Re-Strategize Training cum fellowship sites for ASU.
3.1 In the past we have always talked about the possibility about training sites for UAA and ASU. It has always been a difficult task due to financial and multiple logistics issues.
3.2 What can we do that is possible? Let us consider two options in the next 4 years.
3.3 For the last 6 years a group of Asian urologists started AUGTEG to design and provide two-day surgical training which includes lectures as well as dry and wet lab to develop surgical skills. AUSTEG has direct access to physical training centres in Thailand, South Korea, and China.
ASU will work with AUGTEC to pool resources since we are the same people working on both sides e.g., Anthony Ng (chairman of AUSTEG) Michael Wong (vice chairman) Eddie Chan (treasurer). AUGTEG is registered in HK.
3.4 The second option is to recognise elected university or training Asian centres to allow an attachment for young urologist post residency in a flexible format. ASU will recognise officially these sites as endorsed by UAA. At UAA 2025 , several potential ASU/UAA fellowship sites directors will be presenting their programmes to kickstart this initiative
4. In conclusion, ASU will continue to grow and serve the Asian Urological Community. The above initiatives are only the beginning of a next chapter. Can you contribute your ideas and current available resources for this purpose? If you can, Pls email me personally at email@drmichaelwong.com
Which Position is the Best for PCNL in 2025?With tremendous advances in both technique and technology , the MIS approach to staghorn calculi has evolved significantly over the last 30 years.
It is timely to review all the landmark articles on patient positioning as this ultimately determines renal access which in turn plays a major role in stone free rates. We will gain much insight as we debate and attempt to answer the question of which position is best in 2026!
-
Jeremy TeohHong Kong, China
Speaker
Transurethral En Bloc Resection of Bladder Tumor: Where Are We Now?There is increasing evidence that transurethral en bloc resection of bladder tumour (ERBT) could lead to better peri-operative and oncological outcomes in patients with non-muscle-invasive bladder cancer. Modified approaches of ERBT have also been proposed to expand its indications for larger bladder tumours. The quality of resection is also the key for bladder-sparing treatment for muscle-invasive bladder cancer. We foresee an exciting journey ahead for ERBT, and as a urologist, we must embrace this novel technique for the best interest of our bladder cancer patients. To Publish or not to Publish? Navigating the path to academia in urologyDoing good science is the basis for technological advancement in healthcare. However, pursuing a path to academic in urology is often tough, stressful and frustrating. In this talk, I will share with you what I have learnt throughout my 15 years of research work. I will let you know what's the best and fastest way to become a globally renowned and successful researcher. Most importantly, I will explain what it takes to develop a great team and create a positive impact in people's lives. Believe in yourself! If I can do it, so can you.SIU Lecture: Role of MISTs in Male LUTS Surgical Management (Will TUR-P/ Laser Prostatectomy be Replaced?)Transurethral resection of prostate (TURP) is the current gold standard in treating patients with benign prostatic hyperplasia. Laser prostatectomy has also been used widely especially in patients who are on anticoagulants. However, both TURP and laser prostatectomy are associated with several problems including the need of spinal / general anaesthesia and the risk of male sexual dysfunction. In the past decade, we have witnessed the introduction of multiple new technologies including Rezum, Urolift, iTind and Aquablation. in this SIU lecture, we will discuss about the technical details, as well as the pros and cons of every new technology. We will also invite you to be our jury and decide whether TURP and laser prostatectomy will be replaced in the future. Novel Intravesical Therapeutics in the Evolving Landscape of NMIBCNon-muscle-invasive bladder cancer (NMIBC) is well known to be a difficult disease to manage, with a 1-year recurrence rate of up to 61% and 5-year recurrence rate of 78%. Despite the use of intravesical BCG therapy, NMIBC patients may still experience recurrence and develop what we call BCG-unresponsive NMIBC. Conventionally, we offer upfront radical cystectomy for patients with BCG-unresponsive NMIBC, however, this is an ultra-major surgery with significant risk of complications and could also lead to significant deterioration in quality of life in the long run. We are in urgent need for novel therapies to manage this difficult condition. In this lecture, we will discuss the evidence on the different novel intravesical therapies in treating BCG-unresponsive NMIBC. SIU Lecture: Role of MISTs in Male LUTS Surgical Management (Will TUR-P/ Laser Prostatectomy be Replaced?)
-
Henry HoSingapore
Speaker
Technical Pearls: Wheel-Barrow TechniquesBringing Innovation to PatientRobotic Partial Nephrectomy: Beyond Technique
-
Yao-Chi ChuangTaiwan
Speaker
Road to Excellent ResearchYao Chi Chuang, Professor of Urology, Kaohsiung Chang Gung Memorial Hospital, and National Sun Yat-sen University Taiwan.
Medical research is what allows doctors to explore unmet medical need and decide how to best treat patients. It is what makes the development of new diagnostic tools, new biomarkers, new medicines, and new procedures. Without medical research, we would not be able to creative new knowledge and decide if new treatments are better than our current treatments.
There are some Tips on what to do about what research is and how to get into it:
1. Ask a good question from your daily practice, what is unmet medical need?
2. Search the old literature of your research interests- what is known? What is unknown?
3. Find a new method to solve your question or an old method but applying to a new field.
4. Start from jointing a pre-planned research project, and join a research collaborative.
5. Try to be an independent researcher from a small project without funding support, retrospective study.
6. Try to get funding support from your institute, national grant, or industry.
As a young doctor, it’s important to look after yourself and maintain a healthy balance between daily practice and research work. There is a range of options for doctors interested in research, from smaller time commitments as a co-investigator to longer-term projects and experience as chief investigator. Research works are all optional activities, so do what you can but don’t overwhelm yourself. Road to Excellent Research
-
Eddie ChanHong Kong, China
Speaker
How to Escape Surgical ComplicationsSurgical complications can significantly impact patient outcomes and healthcare resources. This talk will focus on practical strategies to minimize complications in urologic surgery, tailored specifically for urology fellows. Real-life case examples will illustrate how thoughtful preparation and proactive communication can prevent or mitigate complications. Additionally, we will discuss structured approaches to managing complications when they arise, including communication with the patient and team, documentation, and timely intervention. Through real-life case examples, this session aims to enhance surgical judgment, promote patient safety, and build confidence in complication management.
-
TICC - 3F Banquet Hall
|
Renal Cell Carcinoma
-
-
Siros JitpraphaiThailand
Speaker
RCC and IVC ThrombectomyRCC and IVC thrombus
Siros Jitpraphai
Division of Urology, Department of Surgery,
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, THAILAND
Abstract
Renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus represents a complex surgical challenge, with an incidence of venous involvement in 4-10% of cases. This case report demonstrates the successful surgical management of a 58-year-old female patient with a large left-sided renal mass and IVC thrombus. The patient presented with gross hematuria and was diagnosed with a 10 cm clear cell renal cell carcinoma (Fuhrman nuclear grade 3) extending into the renal vein and IVC. Recognizing the complexity of the case, a multidisciplinary approach was employed, involving urological and hepatobiliary surgical teams. The comprehensive treatment strategy included an open radical nephrectomy with IVC thrombectomy. The surgical technique was meticulously planned and executed, with several key considerations. Preoperative imaging was crucial in determining the exact level of thrombus, allowing for precise surgical planning. The procedure emphasized careful vascular control and en-bloc tumor removal, with intraoperative ultrasound used to ensure accurate thrombus localization. Surgical teams worked collaboratively to minimize potential complications and maximize surgical success. Operatively, the procedure was substantial, with an estimated blood loss of 900 mL and a total operative time of 5 hours. The patient required two days of postoperative intensive care and was discharged from the hospital seven days after the surgery. Pathological examination confirmed the diagnosis of clear cell renal cell carcinoma, with no lymph node metastasis detected and positive tumor thrombus. Importantly, surgical margins were found to be free of tumor.
Follow-up evaluations have been encouraging, with no signs of tumor recurrence observed during regular intervals. This case illustrates the critical importance of a systematic surgical approach, precise technical execution, and comprehensive multidisciplinary management in successfully treating RCC with IVC thrombus. It provides valuable insights into the complex surgical management of this challenging condition, potentially offering guidance for similar cases in the future.
Keyword: RCC (Renal Cell Carcinoma), IVC Thrombus, Thrombectomy, Surgical Technique, Multidisciplinary Management
Highlight: RCC with IVC thrombus is a complex surgical challenge affecting 4-10% of cases. Successful management requires meticulous preoperative imaging, multidisciplinary team approach, and precise surgical technique. With careful planning and execution, 45-70% of patients can be cured through radical nephrectomy and IVC thrombectomy.
Robotic Partial Nephrectomy in Complex and Difficult Tumor Location
-
Surya Prakash VaddiIndia
Speaker
Cytoreductive Nephrectomy in the Era of Immune TherapyRobotic Partial Nephrectomy in Tumors with High Renal Score
-
-
Po-Hung LinTaiwan
Speaker
Robotic Prostatectomy Using da Vinci SP SystemIn this semi-live section I will demonstrate the steps of extraperitoneal-approach radical prostatectomy using DAVINCI SP system.How to Make the Best Decision with Systemic Therapy Sequence in Respective of Genetic AnalysisRenal cell carcinoma (RCC) is a biologically heterogeneous disease driven by a limited set of convergent pathways that together shape oncogenesis, immune evasion, and therapeutic response. Across clear-cell RCC (ccRCC), recurrent alterations include VHL, PBRM1, BAP1, and SETD2, mapping onto five dominant axes: hypoxia signaling (VHL–HIF), PI3K/AKT/mTOR, chromatin remodeling, cell-cycle control, and metabolic rewiring. These lesions variably interact—e.g., mTORC1 enhances HIF translation—creating therapeutic opportunities (VEGF tyrosine-kinase inhibitors, HIF-2α inhibition, mTOR blockade) and constraints (adaptive resistance via metabolic plasticity). While immune checkpoint inhibitors (ICIs) and ICI–TKI combinations have improved outcomes in metastatic RCC, robust predictive biomarkers remain elusive. Tumor mutational burden is typically low and noninformative; PD-L1 shows assay- and context-dependent utility; PBRM1 and BAP1 are more prognostic than predictive. Emerging signals include angiogenic versus T-effector/myeloid transcriptional signatures, sarcomatoid/rhabdoid histology as a surrogate of immune-inflamed state, and host factors such as HLA genotype and gut microbiome composition. Liquid-biopsy modalities (ctDNA and methylome profiling) and spatial/single-cell atlases reveal intratumoral heterogeneity, T-cell exclusion niches, and myeloid programs (e.g., TREM2⁺ macrophages) linked to recurrence or ICI benefit. Early data support metabolism-targeted strategies (e.g., glutaminase inhibition) and rational combinations co-targeting angiogenesis, hypoxia signaling, and immune checkpoints; however, toxicity management and resistance evolution require prospective, biomarker-integrated trials. A clinical schema that pairs baseline multi-omic and microenvironmental profiling with adaptive surveillance (serial liquid biopsies, functional imaging) can lead to dynamically select among ICI–ICI, ICI–TKI, targeted, and experimental regimens. Robotic Prostatectomy Using da Vinci SP System
-
Seong Il SeoKorea (Republic of)
Speaker
Comparison of Remal Function between Radiofrequency Ablation versus Robot Assisted Laparoscopic Patial Nephrectomy for Small Renal Mass in Elderly PatientsComparison of renal function between radiofrequency ablation versus robot assisted laparoscopic partial nephrectomy for small renal mass in elderly patients
Jiwoong Yu, Seongil Seo
Sungkyunkwan University, Samsung Medical Center
The incidence of small renal masses (SRMs) in patients ≥75 years has increased up to 30-fold [J Urol 2014]. In this age group, treatment should balance cancer control and renal function preservation. Robot-assisted partial nephrectomy (RAPN) and radiofrequency ablation (RFA) are two main options.
RAPN offers excellent cancer control but requires general anesthesia and ischemia, which may pose risks in older patients. RFA is less invasive, avoids vascular clamping, and is often preferred for high-risk patients, as supported by EAU and AUA guidelines.
RFA generally preserves renal function better [Front Oncol 2022], though outcomes vary by technique. At our center, RFA under general anesthesia with wide safety margins may compromise parenchymal preservation.
While both approaches show favorable cancer control, RFA has a slightly higher recurrence rate. Pantelidou et al. reported 6 recurrences in 63 RFA cases vs. 1 in 63 RAPN cases [Cardiovasc Intervent Radiol 2016], and Park et al. reported 2-year recurrence-free survival (RFS) of 95.2% in RFA vs. 100% in RAPN [Eur Radiol 2018]. NCCN guidelines note that RFA may require repeat treatment to match surgical outcomes.
Our institutional matched analysis (63 RAPN vs. 63 RFA) showed RFS of 100% vs. 95.2% (p = 0.029), and immediate eGFR preservation of 91.7% vs. 86.8% [Eur Radiol 2018;28:2979–2985]. A subsequent analysis of older patients presented at AUA 2024 included 137 patients aged ≥75, the rate of ≥25% eGFR decline at one year was 28.6% for RFA vs. 2.0% for RAPN (HR 11.3, p = 0.002), with 4 recurrences in RFA and none in RAPN.
In conclusion, both RFA and RAPN are viable options for elderly patients with small renal masses. RFA is less invasive but may carry a slightly higher risk of recurrence and, depending on institutional technique, some degree of renal function loss. Treatment should be individualized based on tumor anatomy, patient condition, and institutional expertise.
-
Steven L. ChangUnited States
Speaker
The Progression Landscape of Diagnostic and Treatment Options for Kidney CancerPros and Cons in the daVinci SP System Applications in Urological Surgeries
TICC - 2F 201BC
|
Updating Management Strategies for Female Pelvic Floor Dysfunction
-
-
Sonthidetch SivilaikulThailand
Speaker
Exploring Non-Surgical Treatments for Pelvic Organ Prolapse: What Does the Evidence Says?Pelvic organ prolapse (POP) is a prevalent condition among women, particularly in the postmenopausal population, and it significantly impacts quality of life. While surgical intervention remains a definitive treatment for moderate to severe cases, non-surgical management has garnered increasing attention as a viable alternative, especially for women who are asymptomatic, medically unfit for surgery, or prefer conservative options. This review explores current evidence regarding non-surgical therapies for POP, focusing on pelvic floor muscle training (PFMT), pessary use, lifestyle modifications, and emerging modalities such as vaginal estrogen therapy and electrical stimulation. Clinical trials and meta-analyses suggest that PFMT can improve prolapse symptoms and halt progression in early-stage POP, while pessaries offer an effective mechanical solution for symptom relief and support. However, the quality of evidence varies, with many studies limited by small sample sizes and heterogeneity in outcome measures. Ultimately, non-surgical treatments serve as an important component of personalized care strategies for managing POP.
-
Sakineh HajebrahimiIran
Speaker
Surgical Options for Apical Prolapse: Comparing Trans-Vaginal and Trans-Abdominal Approaches Surgical Options for Apical Prolapse: Comparing Transvaginal and Transabdominal Approaches
Background
Apical prolapse represents a significant subset of pelvic organ prolapse cases and can profoundly impact quality of life. Surgical correction remains the cornerstone of management, with both transvaginal and transabdominal approaches offering distinct advantages and limitations. The optimal surgical pathway continues to be debated among pelvic floor surgeons.
Objective
To critically compare transvaginal and transabdominal surgical approaches for apical prolapse, focusing on anatomical and functional outcomes, complication profiles, and long-term durability.
Methods
A comprehensive review of current literature, including randomized controlled trials, prospective cohort studies, and meta-analyses, was performed. Surgical techniques assessed included vaginal sacrospinous ligament fixation, uterosacral ligament suspension, and transabdominal sacrocolpopexy (open, laparoscopic, and robotic-assisted). Outcome measures included anatomical success rates, recurrence rates, functional urinary and sexual outcomes, operative morbidity, and patient-reported quality of life.
Results
Transabdominal sacrocolpopexy demonstrates superior long-term anatomical durability and lower recurrence rates, particularly for advanced prolapse, but is associated with longer operative time and higher perioperative morbidity. Transvaginal approaches offer shorter recovery times, lower immediate postoperative complications, and feasibility in high-risk surgical candidates, but may have higher rates of recurrent prolapse over extended follow-up. Minimally invasive abdominal approaches, especially robotic-assisted techniques, may bridge the gap between durability and reduced morbidity.
Conclusion
Choice of surgical approach for apical prolapse should be individualized, balancing patient-specific anatomical, functional, and comorbidity profiles against surgeon expertise and available resources. Ongoing high-quality comparative studies are essential to refine patient selection criteria and optimize long-term outcomes.
Keywords
Apical prolapse, sacrocolpopexy, sacrospinous fixation, transvaginal surgery, pelvic floor reconstruction, robotic surgery
-
Véronique PhéFrance
Speaker
New Artificial Urinary SphinterStress urinary incontinence remains a major quality-of-life concern, particularly following pelvic surgery. Despite being the gold standard, the AMS 800 artificial urinary sphincter (AUS) presents significant limitations, including mechanical failure, urethral atrophy, and challenges for elderly or disabled patients. Recent innovations in AUS design now incorporate mechatronics, remote control, adaptive pressure systems, and miniaturized components aimed at improving usability, autonomy, and continence outcomes. This presentation reviews the current landscape of next-generation AUS, focusing on ARTUS, UroActive®, and other devices under clinical evaluation. We discuss preclinical and first-in-human data, regulatory pathways, patient-reported preferences, and remaining barriers such as infection risks and training requirements. Intelligent, connected AUS devices hold promise to transform continence care after decades of technological stagnation.Choosing between Laparoscopic Sacrocolpopexy and Lateral Suspension: Weighing the Pros and ConsPelvic organ prolapse (POP) is a common condition requiring surgical intervention to restore apical support. Among minimally invasive options, laparoscopic sacrocolpopexy (LSCP) remains the gold standard, while laparoscopic lateral suspension (LLS) is gaining renewed interest for its reduced invasiveness and simplified technique. This presentation compares LSCP and LLS across multiple dimensions: anatomical restoration, functional outcomes, complication profiles, patient selection, and surgical learning curves. LSCP offers robust long-term results and better posterior compartment support but carries increased operative complexity. LLS provides effective anterior/apical correction with fewer vascular risks and a shorter learning curve. Both techniques have comparable mesh exposure rates and subjective success. Individualized decision-making based on patient anatomy, comorbidities, and surgeon expertise remains key. Emerging technologies and robotic assistance may further refine these approaches in the future.Robotic Novel Artificial Urinary Sphincter ImplantationThis video shows a step by step robotic artificial urinary sphincter implantation in women using AMS800 and Artus devices.First robot-assisted implantation of ARTUS (Affluent Medical) electromechanical artificial urinary sphincter in a female cadaverIntroduction
Artificial urinary sphincters (AUS) are effective tools for the treatment of female stress urinary incontinence. Nonetheless, hydraulic sphincters present with some limitations: complex and time-consuming preparation, need for preserved manual dexterity and constant pressure exertion on the bladder neck. The ARTUS® Artificial Urinary Sphincter is a novel electro-mechanical device designed to overcome these limitations thanks to its rapid and straight-forward implantation, intuitive remotely controlled manipulation and continuously adjustable cuff pressure.
Materials and methods
The ARTUS® system is currently under pre-market investigation in men, in an interventional, prospective, single arm, multicentric, international study. A cadaver lab session was carried out in Decembre 2024 to test the technical feasibility of ARTUS® implantation in female patients. The procedure was performed by an expert surgeon with extensive experience in AUS implantation and robotic surgery.
Results
One female patient was successfully implanted during the session. The technique has been developed following the principles of the traditional robot-assisted AUS implantation: the patient is placed in gynecological 23° Trendelenburg position. The robot has a 4-arms configuration. The procedure starts with the dissection of the vesicovaginal plane, to approach the bladder neck posteriorly. The lateral surfaces of the bladder neck are developed on both sides. The anterior peritoneum is opened to gain access to the antero-lateral surfaces of the bladder. The separation of the bladder neck from the vagina is performed through dissection of the pre-vaginal fascia bilaterally. The cuff is introduced and it is passed through the antero-lateral peri-vesical spaces, sliding behind the bladder neck from the right side to the left side. The anterior peritoneum is opened to gain access to the anterior surface of the bladder neck. The cuff is closed anteriorly, passing the transmission line inside the hole at the distal part of the cuff. The tightening around the bladder neck is achieved by pulling the transmission cable through. An optimal adjustment of the cuff around the bladder neck is provided tightening the ARTUS cuff clamping notch. Then, a supra-pubic 4 cm skin incision is made to implant the control unit. The tip of the cuff is passed outside through the incision. A lodge is prepared incising along the external oblique muscle aponeurosis. The cuff is connected to the control unit and a test with the remote control is performed to verify the functioning of the system. Finally, the control unit is placed into the lodge, anchored with non-absorbable sutures to the aponeurosis.
Conclusions
Robot-assisted ARTUS® implantation is technically feasible in female patients. This straight-forward technique may reduce operative time. The device has the potential to reduce the pressure and facilitate manipulation in patients with impaired dexterity.
-
Howard GoldmanUnited States
Speaker
Anti-Cholinergics: Does Treating the Bladder Put the Brain at Risk?Recent evidence suggests an association between Overactive Bladder Anticholinergic medication and dementia. Do these medications really increase one's risk of dementia. We will examine the evidence.Surgical Treatments for Recurrent SUI/POPEven the best of surgeon's will have patients who have recurrence after a stress incontinence or pelvic organ prolapse procedure. If the recurrent is bothersome the patient may need repeat surgery. How to decide on the ideal surgery for recurrent symptoms will be examined
-
Raymond Wai-Man KanHong Kong, China
Speaker
Female Bladder Outlet Obstruction & Urinary Retention: Considerations beyond POPFemale bladder outlet obstruction has been an under-recognised disease entity, however that does not imply the rarity of this condition. There are limitations in urodynamic evaluation for this condition and fluoroscopy can often help in the decision making process. Urinary retention in women shares common etiology with bladder outlet obstruction, unlike men however, these two groups of patient do not overlap as much. Management of women with bladder outlet obstruction and urinary retention should be individualised.
-
TICC - 2F 201DE
|
Debate on Pediatric VUR and UPJO
-
Stephen S. YangTaiwan
Speaker
UTI & Hydronephrosis: What's New and Asian Guideline UpdateHydronephrosis is a common urological condition in both adults and children. It is frequently associated with urinary tract infection (UTI). However, not all hydronephrosis means upper urinary tract obstruction (UUTO). So, differentiating hydronephrosis into pathological or physiological is important. In pathological hydronephrosis or UUTO, risk factors of UTI should be identified. While in physiological UTI, no further study is required.
In this lecture, classification of upper urinary tract dilatation will be introduced, including SFU and UTD system. Other than intra-venous pyelourography, diuretic renal scan can be useful in differentiating hydronephrosis into physiological or pathological hydronephrosis. Pitfalls in interpreting diuretic renogram will be discussed. A brief review of risk factors of UTI will be done. Finally, Asian guideline on UTI will be updated.
-
Yu-Chen ChenTaiwan
Moderator
What We Should Know about Sexual Development Disorders Disorders of Sexual Development (DSDs) represent a spectrum of congenital conditions involving atypical development of chromosomal, gonadal, or anatomical sex. Early identification and accurate diagnosis are essential for guiding clinical management and psychosocial support. This talk will provide an overview of the classification of DSDs, including 46,XX DSD, 46,XY DSD, and sex chromosome DSDs, and highlight key diagnostic steps such as hormonal profiling, genetic testing, and imaging studies. Common conditions such as congenital adrenal hyperplasia (CAH), androgen insensitivity syndrome (AIS), and gonadal dysgenesis will be discussed, with emphasis on a multidisciplinary approach involving pediatric endocrinologists, geneticists, surgeons, and psychologists. Practical considerations in gender assignment, surgical timing, and long-term follow-up will also be addressed. This session aims to equip urology residents with the essential knowledge to recognize and contribute to the care of patients with DSDs.
-
-
Shin-Mei WongTaiwan
Speaker
Opposition to VUR SurgeryVesicoureteral reflux (VUR) is closely associated with urinary tract infections (UTIs) and renal scarring in neonates and children. Primary VUR attributes its pathogenesis to a congenitally short submucosal ureteral tunnel, resulting in inadequate ureterovesical junction resistance. This concept has informed the development of various surgical techniques aimed at increasing ureteral resistance. However, emerging evidence suggests that surgical correction does not consistently offer superior long-term renal outcomes compared to continuous antibiotic prophylaxis (CAP). This raises important concerns regarding the role of surgery as the treatment for high-grade VUR. Given the heterogeneity of VUR, underlying factors such as elevated detrusor pressure, increased urethral resistance, or persistently low ureteral resistance must be thoroughly evaluated and addressed prior to surgical intervention. As VUR remains one of the most debated conditions in pediatric urology, further studies are essential to improve risk stratification and refine treatment algorithms to optimize both infection control and renal preservation.
-
-
Yu-Hua FanTaiwan
Moderator
Updates on Vesicoureteral RefluxVesicoureteral reflux (VUR) remains a critical topic in pediatric urology, with ongoing debates surrounding its diagnosis, management, and long-term outcomes. This presentation will provide an updated overview of the current understanding of VUR, including recent advances in imaging techniques, risk stratification, and non-surgical versus surgical treatment options. Emerging evidence on the natural history of VUR, the role of continuous antibiotic prophylaxis, and evolving criteria for surgical intervention will be discussed. The session will also highlight recent guideline updates, innovations in endoscopic injection materials, and strategies for individualized patient care. By integrating recent clinical data and expert consensus, this talk aims to provide practical insights into optimizing VUR management in contemporary practice.
-
-
Shang-Jen ChangTaiwan
Speaker
Which Surgical Treatment is Best for UPJO in Infants: Open, Laparoscopic, Robotic AssistedAbstract
Ureteropelvic junction obstruction (UPJO) in infants is a condition that can significantly impair renal function and requires timely surgical intervention when certain criteria are met, such as decreased split renal function, poor drainage on diuretic renography, or recurrent urinary tract infections. The three main surgical approaches for treating UPJO are open pyeloplasty (OP), laparoscopic pyeloplasty (LP), and robot-assisted laparoscopic pyeloplasty (RALP). Each technique has its own benefits and limitations, especially when applied to infants.
Minimally invasive surgery (MIS), including LP and RALP, has gained popularity in pediatric urology due to advantages such as shorter hospital stays, reduced postoperative pain, faster recovery, and better cosmetic outcomes. However, the small working space in infants, the steep learning curve, and higher costs are significant limitations. In particular, the utility of MIS in infants remains controversial due to undefined benefits and technical challenges, including limited space for trocar placement and difficulty in intracorporeal suturing.
Current guidelines from the European Association of Urology (EAU) indicate that while RALP is considered the gold standard for older pediatric patients, its role in infants remains less defined due to anatomical and logistical constraints. Open surgery continues to be the mainstay for infantile UPJO due to its well-established success rate and lower cost.
Several studies have addressed the learning curve associated with these techniques. Laparoscopic pyeloplasty requires about 30 cases for a surgeon to achieve proficiency, while RALP demands approximately 18–31 cases depending on the metrics used. Simulation-based training, dry labs, and multicenter collaboration are proposed solutions to accelerate skill acquisition and ensure patient safety.
Cost is another critical consideration. Although RALP generally incurs higher upfront costs, especially in low-volume centers, innovations such as magnetic stents have helped offset some of these expenses by eliminating the need for anesthesia during stent removal. Moreover, the availability of pediatric-specific robotic instruments remains limited and necessitates ongoing development to fully support MIS in smaller patients.
In conclusion, while RALP is increasingly recognized as the standard for pediatric UPJO, its application in infants should be considered selectively, depending on surgeon experience, institutional resources, and patient anatomy. Open pyeloplasty remains a safe and effective option, particularly in very young children. Advances in surgical training, cost reduction strategies, and instrument development will be key to expanding the use of minimally invasive techniques in this population.
-
Sujit ChowdharyIndia
Speaker
How I do It: Laparoscopic and Robotic Assisted Pyeloplasty aim is to present the technical points with illustrative cases on the learning experience of
over 600 newborn / open / laparoscopic / robotic pyeloplasties for Pelviureteric junction
obstruction along with long term follow up and management approach to complications
over a twenty year follow up .
-
-
TICC - 2F 201AF
|
|
13:30
15:00
|
Infectious Disease / Urologic Trauma
TICC - 1F 101A
|
Advancing Focal Therapy in Localized Prostate Cancer: From Patient Stratification to Post-HIFU Management
-
-
-
-
Peter Ka-Fung ChiuHong Kong, China
Speaker
Minimal Invasive Therapy: Where do We Stand in 2025Endourological, Laparoscopic and robotic surgeries have replaced most open surgeries in Urology. Emergence of new robotic platforms have provided urologists with new opportunities. Both boom-type and module-type robots have been used, and they each have their strengths in practice. Tele-surgeries have provided a new paradigm of long-distance robotic surgeries to facilitate new surgical possibilities and proctorship. State of the art robotic surgeries in retrograde intrarenal surgeries and enbloc resection MDT Discussion: Personalizing Treatment in High Volume CSPCN/ADebate: Should We Only Offer Consolidative Cytoreductive Nephrectomy in Metastatic RCC?N/AFocal Therapy in Asia – Is It Prime Time?The increase in incidence of Prostate cancer has been rapid in Asia in the past 10 years. While Robotic radical prostatectomy and Radiotherapy has been the commonest treatments for localized prostate cancer, significant long-term morbidities are observed after surgery or radiotherapy including incontinence, erectile dysfunction and irradiation injury to the bladder and rectum. In the current era of MRI-guided prostate biopsy, focal diseases can be targeted and diagnosed, and image-guided focal therapy emerged as an alternative treatment. Although Focal therapy has a relatively higher rate of local recurrence, it has the advantages of minimal or no long-term complication after treatment, and it is possible to perform retreatment with focal therapy, prostatectomy or radiotherapy. In properly selected patients, the need for salvage prostatectomy or radiotherapy after focal therapy is less than 20% at 8 years, and patients’ quality of life could be preserved. In well-selected patients, focal therapy is an attractive option. Current focal therapy for prostate cancer available in Asia includes HIFU, Cryotherapy, Targeted Microwave Ablation (TMA), irreversible electroporation (IRE) and TULSA.
-
-
-
-
TICC - 1F 101B
|
Redefining the journey of Genitourinary Cancer patients with Nivolumab
TICC - 1F 101C
|
-
Hammad Ather Pakistan
Moderator
Current Evidence Supporting Adjuvant and Neo-Adjuvant TreatmentThe Upper Tract Urothelial Cancer (UTUC) is increasingly being considered as a genetic disorder. Following RNU, the IHC can detect a deficiency in mismatch repair proteins or microsatellite instability (MSI) using PCR. In the presence of MSI, it is necessary to undergo germline testing. High-grade UTUC is an aggressive cancer and is often associated with micrometastases, resulting in early recurrence and development of metastases. Risk classification and recognising more aggressive cancers in whom adjuvant or even neoadjuvant chemotherapy may be of benefit. One of the most crucial steps in considering patients for chemotherapy is the platinum eligibility, renal function (<30ml/min), functional status (ECOG >2) and comorbidities >2 grade are considered ineligible. There is good-quality evidence of improved survival for adjuvant chemotherapy in eligible patients following RNU for pT2–T4 and/or pN+ disease. The 2025 EAU guidelines recommend discussing adjuvant nivolumab with PD-L1-positive patients unfit for, or who declined, platinum-based adjuvant chemotherapy for ≥ pT3 and/or pN+ disease after previous RNU alone or ≥ypT2 and/or ypN+ disease after previous neoadjuvant chemotherapy, followed by RNU. However, the evidence supporting this recommendation is weak. Single intravesical chemotherapy is strongly recommended. There is currently no level 1 evidence supporting neo-adjuvant chemotherapy; however, non-randomised series have shown a decreased incidence of positive surgical margins, recurrence, and improved survival over RNU alone.Avoiding Complication in Orthotopic NeobladderIn most large series from Europe, approximately 1-2 of every 10 patients undergoing radical cystectomy have an orthotopic neobladder (ONB). Data is supporting ONB in terms of quality of life, cosmetics, and improved patient satisfaction. Early and late morbidity in up to 22% of patients is reported. The terminal ileum is the GI segment most often used for orthotopic bladder substitution. With ileo-ureteral anastomoses, there is UUT reflux, and renal functional deterioration is a concern. Various forms of UUT reflux protection, including a simple isoperistaltic tunnel, ileal intussusception, tapered ileal prolongation implanted subserosally, and direct (sub)mucosal or subserosal ureteral implantation, have been described. Superiority of one over the other is not proven. Urethral recurrence is a significant concern; therefore, patient selection must be optimal. Short-term complications are related to the GI tract, including atelectasis and metabolic acidosis. They are all preventable with standardised post-operative measures. The ERAS protocol is particularly useful in avoiding short-term complications and decreasing postoperative hospital stay, among other benefits. The key to success in preventing complications is meticulous patient selection and the implementation of preemptive measures to avoid common complications.Prostate Biopsy Technique: Current EvidenceOptimal prostate biopsy is critical in risk-stratifying patients for appropriate patient care. The traditional TRUS-guided biopsy is associated with UTI sepsis and other infectious complications. Recently, the use of the transperineal route has been advocated for the diagnosis of prostate cancer. Biopsy is either systematic or targeted. There is evidence supporting the notion that MRI-targeted biopsy without systematic biopsy significantly reduces the over-diagnosis of low-risk disease, compared to systematic biopsy. This seems true even when systematic biopsies are indicated after risk stratification with the Rotterdam Prostate Cancer Risk Calculator. EAU recommends performing prostate biopsy using the transperineal approach due to the low risk of infectious complications and better antibiotic stewardship. They also recommend using either target prophylaxis based on rectal swab or stool culture, or augmented prophylaxis (two or more different classes of antibiotics), for transrectal biopsy.
-
-
Vinod K.VIndia
Speaker
Testosterone Therapy: Implications for Cardiovascular Health Sexual Function Preservation in MIS for BPH
-
-
-
-
Michael WongSingapore
Moderator
Introduction to Asia School of UrologyAsian School of Urology 2022-2026 – New initiatives
Dr Michael YC Wong
Principal Director of ASU 2022-2026
President Endourological Society and WCET 2026
Introduction
Asian School of Urology (ASU) officially started in 1999 with the appointment of her first director Prof Pichai Bunyaratavej from Thailand (1999-2002) Subsequent directors were Dato Dr Rohan Malek from Malaysia (2002-2006) Prof Foo Keong Tatt from Singapore (2006-2010) Prof Rainy Umbas from Indonesia (2010-2014 ) and Prof Shin Egawa from Japan ( 2014-2022 ).
One of the highlights of the ASU in the early days were the organization of several workshops outside of UAA congress by three active sub-specialty sections of UAA namely Asian society of Endourology (over 16 workshops held from 1998-2008), Asian Society of Female Urology and Asia-Pacific society of Uro-Oncology. Other subspecialty sections were subsequently introduced and have matured very well including Asian Society of UTI and STI, Asian-Pacific Society of Andrological and Reconstructive Urology Surgeons.
In the last 8 years, ASU has seen tremendous growth under the steady leadership of Prof Shin Egawa with introduction of UAA lecturers at national Meetings and further maturation of the subspecialty sections of UAA e.g., Conversion of Asian society of endourology to Asian Robotic Urological Society to reflect the growth and development of UAA. During the past 8 years, ASU-South-East Asia section has also managed to organize 15 physical workshops and 4 webinars outside of UAA congress.
The Growth Trajectory for the next 4 years 2022-2026
There are many areas where ASU can grow further. Bearing in mind our limited resources and our excellent relationships with the world urological leaders at this point in our history.
There are three areas which I will focus on. Please remember that ASU is always open to other new initiatives as we must stay relevant to our Asian urological community.
1. Lasting and strong Relationships
1.1 AUA. Over a dish of chili crab with AUA secretary general Gopal Badlani, we explored the common desire to elevate Asian Urology and strengthen UAA Family. This led to our first joint UAA-AUA residency course at UAA Singapore 2016. After successful completion, a MOU was signed at AUA 2017 with Richard Babayan, Manoj Monga, Allen Chiu and myself in attendance. The AURC at UAA Hong Kong under Prof Eddie Chan was the result of this signed MOU. We are extremely grateful for the generosity of AUA for this program. What may not be obvious is that Gopal Badlani, Manoj Monga, John Denstedt and I served as faculty and board directors at WCE. We will sign the extension MOU in 2023 for another three years.
1.2 EAU. We have a very successful UAA-EAU Youth program since UAA Thailand 2012. This has been the work of several UAA senior members. From 2023, we are exploring joint webinars with EAU to build on this relationship.
1.3 SIU and WCE. We will further explore options based on available resources and manpower. Joint Webinar are planned for early 2026
2. Education Platform for Asian Urology Residents
From 2023, we will continue to grow our relationship with BJUI. BJUI has developed a world class online learning platform with tremendous investments since 2013. This platform is called BJUI Knowledge. ASU will reach out to all Asian residents via their national urological association president and secretary to encourage every resident to sign up for a free access to more than 420 interactive 30-minute modules covering the whole urology syllabus suitable for learning, exit exams and recertification exams. I am personally involved in developing all modules under Endourology and urolithiasis Section and have been associate editor since May 2013. The modest aim is for at least 10 residents per country to sign up by UAA 2023. We will report progress at each UAA council meeting. Pls see attached information and if there are any questions pls email me personally at email@drmichaelwong.com
3. Re-Strategize Training cum fellowship sites for ASU.
3.1 In the past we have always talked about the possibility about training sites for UAA and ASU. It has always been a difficult task due to financial and multiple logistics issues.
3.2 What can we do that is possible? Let us consider two options in the next 4 years.
3.3 For the last 6 years a group of Asian urologists started AUGTEG to design and provide two-day surgical training which includes lectures as well as dry and wet lab to develop surgical skills. AUSTEG has direct access to physical training centres in Thailand, South Korea, and China.
ASU will work with AUGTEC to pool resources since we are the same people working on both sides e.g., Anthony Ng (chairman of AUSTEG) Michael Wong (vice chairman) Eddie Chan (treasurer). AUGTEG is registered in HK.
3.4 The second option is to recognise elected university or training Asian centres to allow an attachment for young urologist post residency in a flexible format. ASU will recognise officially these sites as endorsed by UAA. At UAA 2025 , several potential ASU/UAA fellowship sites directors will be presenting their programmes to kickstart this initiative
4. In conclusion, ASU will continue to grow and serve the Asian Urological Community. The above initiatives are only the beginning of a next chapter. Can you contribute your ideas and current available resources for this purpose? If you can, Pls email me personally at email@drmichaelwong.com
Which Position is the Best for PCNL in 2025?With tremendous advances in both technique and technology , the MIS approach to staghorn calculi has evolved significantly over the last 30 years.
It is timely to review all the landmark articles on patient positioning as this ultimately determines renal access which in turn plays a major role in stone free rates. We will gain much insight as we debate and attempt to answer the question of which position is best in 2026!
-
-
-
Sasikumar SubramaniamSri Lanka
Speaker
Post Priapism Penile Prosthesis: What and WhenIschemic priapism remains a urological emergency with devastating consequences when not promptly and effectively managed. Among its most feared sequelae is corporal fibrosis leading to irreversible erectile dysfunction. In such cases, timely insertion of a penile prosthesis is often the only viable option to restore sexual function and preserve penile length. This presentation explores the complex decision-making framework surrounding penile prosthesis implantation following priapism.
We will review the current evidence on timing—emergent versus delayed insertion—highlighting the anatomical and surgical challenges posed by fibrotic corporal bodies. The discussion will cover prosthesis type selection, intraoperative considerations, and outcomes data from recent case series and cohort studies. Additionally, we will examine the risks of infection, erosion, and mechanical failure in the post-priapism cohort, comparing them to standard ED populations.
-
Sanjay KulkarniIndia
Speaker
12 cm Peno-Bulbar Stricture due to Lichen SclerosusPan Urethroplasty with Kulkarni technique, bilateral buccaneers mucosa grafts or spiral prepucial graft technique.Oral Mucosa and Beyond: Tissue Substitutes in Urethroplasty
-
-
Rajeev TPIndia
Speaker
Newer Advances in the Endourological Management of Stones – Have We Reached the Zenith
TICC - 1F 101D
|
Transplantation
Cheng-Kuang YangTaiwan
Moderator
Robotic Radical Prostatectomy: Trying to Fit the Right Surgery to the Right PatientDefinitive treatment for localized prostate cancer included radical prostatectomy and radiation. Successful criteria of radical prostatectomy have to meet oncology control, not persistent PSA after surgery without salvage therapy. MRI imaging stage and PSA density are predictors for short‐term BCR after prostatectomy. NCCN‐defined high‐risk patients with a high initial PSA 28 density, imaging stage (T3aN0M0 and T3bN0M0), and 29 pathologic stage (any N1) had a higher risk of BCR when 30 compared with other patients with undetectable PSA, while 31 those with pathologic stage (T3bN0M0 or any N1) displayed 32 a higher risk of postoperatively detectable PSA. These find‐ 33 ings may help urologists to identify patients for whom active 34 therapeutic protocols are necessary.
TICC - 1F 102
|
|
13:30
15:00
|
Oncology Prostate
TICC - 3F South Lounge
|
Functional Urology
TICC - 3F North Lounge
|
Training and Education & AI in Urology
Chi-Fai NgHong Kong, China
Moderator
Novel Robotic Surgery PlatformsOver the past decades, robotic surgery has become an essential approach in urological care. The recent blooming of different robotic platforms, in particular in Asian countries, has helped popularize robotic surgery in less developed countries. The introduction of robotic technology in endoluminal surgery has also helped to open up opportunities to further improve endourology. In the future, the incorporation of AI in robotic systems will help upgrade the standard of care in urology.
William J. HuangTaiwan
Moderator
Male Infertility: Challenges and Opportunities in AsiaMale infertility contributes to nearly 50% of all infertility cases, with an increasing burden observed across Asia. In parallel, a dramatic decline in birth rates has emerged in several Asian countries—including South Korea, Japan, Taiwan, and Singapore—reaching historically low total fertility rates (TFRs) of under 1.0. While multifactorial in nature, this demographic crisis underscores the urgent need to address all aspects of reproductive health, including the often-overlooked role of male infertility. Epidemiological data reveal significant regional disparities in the prevalence, diagnosis, and treatment of male infertility. Cultural stigma, limited andrology training, fragmented referral systems, and inadequate coverage of assisted reproductive technologies (ART) have impeded timely diagnosis and intervention. Environmental exposures, endocrine-disrupting chemicals, occupational heat, and increased paternal age have all been linked to declining semen quality, as evidenced by longitudinal studies showing decreased sperm concentration and motility in several urban centers across Asia. Current diagnostic tools—including semen analysis, hormone profiling, genetic testing (e.g., Y-chromosome microdeletion, karyotyping), and imaging—enable better etiological categorization. Microsurgical sperm retrieval techniques such as mTESE have provided new hope for patients with non-obstructive azoospermia, while ICSI and sperm cryopreservation have become increasingly utilized where available. Nevertheless, access remains inconsistent, particularly outside metropolitan regions. Recent integration of AI-based systems for semen evaluation, patient triage, and digital counseling offers promising strategies to improve care delivery, especially in under-resourced settings. However, data privacy, regulatory standards, and user trust continue to pose barriers to widespread implementation. Opportunities for systemic improvement include the development of regional male infertility registries, integration of andrology into national reproductive health frameworks, expansion of insurance coverage for fertility services, and public awareness campaigns to destigmatize male infertility. In light of Asia’s fertility decline, repositioning male reproductive health as a public health and demographic priority is essential for sustainable population policy and long-term healthcare planning.
The Peri-Operative Care of MIST For Prostate HyperplasiaMinimally invasive surgical therapies (MIST), particularly UroLift and Rezūm, have transformed the treatment landscape for benign prostatic hyperplasia (BPH), offering effective symptom relief with reduced morbidity and preservation of sexual function. However, optimal outcomes depend not only on procedural execution, but also on well-structured peri-operative care protocols encompassing pre-, intra-, and post-operative management. Pre-operative evaluation includes comprehensive assessment of prostate anatomy—especially size, shape, and presence of median lobe—via imaging (TRUS or cystoscopy) to determine candidacy. Careful patient selection is essential: UroLift is typically suited for prostates <80 cc without obstructive median lobes, while Rezūm accommodates broader anatomical variability but may have delayed symptom resolution. Baseline symptom scores (e.g., IPSS), uroflowmetry, and post-void residual volume establish functional benchmarks and guide patient counseling. Anesthesia planning must consider procedural setting and patient comorbidities. UroLift can often be performed under local anesthesia with light sedation, whereas Rezūm may require short general anesthesia or deeper sedation due to thermal discomfort. Appropriate selection reduces intraoperative stress and facilitates same-day discharge. Intraoperative care focuses on minimizing trauma and ensuring device precision. UroLift requires accurate deployment of implants to maintain lateral lobe retraction without compromising sphincter integrity. In Rezūm, the number and duration of vapor injections must be titrated based on lobe size and configuration to balance efficacy and tissue inflammation. Real-time visualization and standardized protocols reduce variability and improve safety. Post-operative management involves anticipating and controlling transient irritative symptoms, such as dysuria, urgency, and hematuria. Alpha-blockers and anti-inflammatory medications are commonly used for 3–7 days post-procedure. Catheterization strategies differ by technique: UroLift may avoid catheter use entirely, whereas Rezūm often requires 7-14 days of catheter drainage due to anticipated edema. Monitoring for urinary retention, UTI, or clot obstruction is critical during the early recovery phase. Follow-up care typically occurs at 2–4 weeks and includes reassessment of voiding function, symptom scores, and patient satisfaction. Reinforcement of realistic expectations is especially important with Rezūm, which may take 4–6 weeks to achieve peak efficacy. Longitudinal studies indicate sustained symptom relief and low retreatment rates when peri-operative care is standardized and patient education is emphasized. Adverse event profiles differ between techniques: UroLift is associated with less dysuria but higher retreatment rates in large prostates, while Rezūm presents higher rates of transient discomfort but favorable durability. Structured peri-operative care pathways—including patient education, standardized medication protocols, and clear complication management plans—enhance recovery, minimize adverse events, and improve overall clinical success.
TICC - 4F Elegance Lounge
|
Oncology Prostate (B)
TICC - 4F Joy Lounge
|
Novel Advances (A): Prostate
TWTC - 1F Exhibition Hall
|
|
13:30
17:00
|
Urodynamics & OAB Management
-
Hann-Chorng KuoTaiwan
Speaker
ACU Lecture: Videourodynamic Study for Precision Diagnosis and Management of Lower Urinary Tract DysfunctionVideourodynamic Study in the Precision Diagnosis and Management of Lower Urinary Tract Dysfunctions
Hann-Chorng Kuo, M.D.
Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan
As a urologist, we are dealing with patients with lower urinary tract symptoms everyday. We did transurethral resection of the prostate (TURP) for elderly men with bothersome lower urinary tract symptoms (LUTS). We put a suburethral sling for women with stress urinary incontinence (SUI). We prescribed alpha-blocker for those who had difficulty in urination. We add antimuscarinics for patients with urgency urinary incontinence. Our seniors always told us these treatments are effective in treating patients with LUTS. However, patients still had LUTS after TURP, women still complained of urgency and dysuria after anti-incontinence surgery. Medication based on storage or emptying LUTS do not work all the time. Why? Because symptoms are not reliable, a large prostate does not indicate bladder outlet obstruction (BOO), and SUI is not solely a result of urethral incompetence. Therefore, in diagnosis and management of LUTS, we need precision medicine to direct an accurate pathophysiology of LUTS, and to guide an appropriate management based on the bladder and bladder outlet dysfunction. When we encounter patients who have LUTS refractory to the treatment based on our initial diagnosis, when we are treating patients who have complicated storage and emptying LUTS, when we are not sure patients could benefit from the invasive procedures for their LUTS, or patients who had both lower and upper urinary tract dysfunctions, videourodynamic study (VUDS) is an essential investigation for diagnosis and management of LUTS. In additional to benign prostate hyperplasia (BPH) and BOO, male patients with emptying LUTS might result from detrusor underactivity (DU), bladder neck dysfunction (BND), urethral sphincter dysfunction, or a hypersensitive bladder, which is not related with the prostate. Patients with BPH and LUTS might have latent neurogenic lesion, such as minor stroke, Parkinson's disease, or early dementia, causing LUTS. TURP without known the neurological disease might exacerbate LUTS after surgery. Mixed SUI comprises intrinsic sphincter deficiency (ISD) and detrusor overactivity (DO). The overactive bladder (OAB) symptoms may also result from an incompetent bladder outlet. Without comprehensive VUDS, we might cure the SUI, but OAB remains after placing a mid-urethral sling. Bladder pain is the cardinal symptoms of interstitial cystitis. However, bladder pain perceived by the patient might also originate from BOO or pelvic floor fascitis. VUDS can help in discrimination. DU and low compliant bladder and ISD could result in complicated storage and emptying LUTS. Large post-void residual (PVR) should alert us to investigate whether it is originated from low compliance or ISD. Dysfunctional voiding (DV) and BND in women with emptying LUTS. OAB symptoms are not always coming from the DO. BOO such as BND, DV, or urethral stricture might exist in men and women without voiding symptoms. Urinary difficulty in women is usually a result from low detrusor contractility, due to DU, or through inhibitory effect from a poorly relaxed pelvic floor or urethral sphincter. A simple bladder neck incision can effectively restore spontaneous voiding in men or women with dysuria due to DU or BND. However, a tight BN is necessary to predict a successful treatment outcome. Patients with central nervous system (CNS) disorders or spinal cord injury usually have complicated LUTD, including DO, BND, DV, detrusor sphincter dyssynergia (DSD), and vesicoureteral reflux (VUR). Management of LUTS in CNS disorders or SCI patients should know the current bladder and bladder outlet dysfunctions. Pediatric incontinence, children with myelomeningocele, DV, or recurrent urinary tract infection are complicated and need precision diagnosis before treatment. Especially when surgery is planned. Lower urinary tract dysfunctions is a dynamic condition. The bladder and bladder outlet dysfunction might change with time. Although VUDS is considered as an invasive investigation with radiation exposure, the advantages in accurate diagnosis and guiding management outweigh these disadvantages.
TWTC - 2F Conference Room 4
|
Flexible Ureterorenoscopy: Technique, Tips, Tricks and Indications
-
Hung-Chieh ChiuTaiwan
Speaker
Erectile Dysfunction and Cardiovascular Health: Insights from the Updated Princeton Consensus1. PDE-5i exposure was associated with lower incidence of MACE, CV death, and overall mortality risk compared to non exposure and risk reduction correlated with PDE-5i exposure level.
2. Highlight of PDE5i and cardiac health in the 4th Princeton Consensus Conference.
3. ED symptoms precede clinically evident CVD by as long as 2 to 5 years.
4. ED management in patients taking nitrate-containing medications or substances.
5. Drug–drug interactions and CV safety of PDE5 inhibitors( real-world observation data) .
6. PDE5 inhibitors may have cardioprotective effects and might play a role in preventative cardiology in the future.
-
Hung-Chieh ChiuTaiwan
Moderator
Erectile Dysfunction and Cardiovascular Health: Insights from the Updated Princeton Consensus1. PDE-5i exposure was associated with lower incidence of MACE, CV death, and overall mortality risk compared to non exposure and risk reduction correlated with PDE-5i exposure level.
2. Highlight of PDE5i and cardiac health in the 4th Princeton Consensus Conference.
3. ED symptoms precede clinically evident CVD by as long as 2 to 5 years.
4. ED management in patients taking nitrate-containing medications or substances.
5. Drug–drug interactions and CV safety of PDE5 inhibitors( real-world observation data) .
6. PDE5 inhibitors may have cardioprotective effects and might play a role in preventative cardiology in the future.
-
-
Hung-Chieh ChiuTaiwan
Moderator
Erectile Dysfunction and Cardiovascular Health: Insights from the Updated Princeton Consensus1. PDE-5i exposure was associated with lower incidence of MACE, CV death, and overall mortality risk compared to non exposure and risk reduction correlated with PDE-5i exposure level.
2. Highlight of PDE5i and cardiac health in the 4th Princeton Consensus Conference.
3. ED symptoms precede clinically evident CVD by as long as 2 to 5 years.
4. ED management in patients taking nitrate-containing medications or substances.
5. Drug–drug interactions and CV safety of PDE5 inhibitors( real-world observation data) .
6. PDE5 inhibitors may have cardioprotective effects and might play a role in preventative cardiology in the future.
Hung-Chieh ChiuTaiwan
Speaker
Erectile Dysfunction and Cardiovascular Health: Insights from the Updated Princeton Consensus1. PDE-5i exposure was associated with lower incidence of MACE, CV death, and overall mortality risk compared to non exposure and risk reduction correlated with PDE-5i exposure level.
2. Highlight of PDE5i and cardiac health in the 4th Princeton Consensus Conference.
3. ED symptoms precede clinically evident CVD by as long as 2 to 5 years.
4. ED management in patients taking nitrate-containing medications or substances.
5. Drug–drug interactions and CV safety of PDE5 inhibitors( real-world observation data) .
6. PDE5 inhibitors may have cardioprotective effects and might play a role in preventative cardiology in the future.
-
-
Hung-Chieh ChiuTaiwan
Moderator
Erectile Dysfunction and Cardiovascular Health: Insights from the Updated Princeton Consensus1. PDE-5i exposure was associated with lower incidence of MACE, CV death, and overall mortality risk compared to non exposure and risk reduction correlated with PDE-5i exposure level.
2. Highlight of PDE5i and cardiac health in the 4th Princeton Consensus Conference.
3. ED symptoms precede clinically evident CVD by as long as 2 to 5 years.
4. ED management in patients taking nitrate-containing medications or substances.
5. Drug–drug interactions and CV safety of PDE5 inhibitors( real-world observation data) .
6. PDE5 inhibitors may have cardioprotective effects and might play a role in preventative cardiology in the future.
Anil ShresthaNepal
Speaker
Clearpetra the Sheath of Choice for Lower Pole StonesSFR Assessment: Timing and Modalities
-
-
Hung-Chieh ChiuTaiwan
Moderator
Erectile Dysfunction and Cardiovascular Health: Insights from the Updated Princeton Consensus1. PDE-5i exposure was associated with lower incidence of MACE, CV death, and overall mortality risk compared to non exposure and risk reduction correlated with PDE-5i exposure level.
2. Highlight of PDE5i and cardiac health in the 4th Princeton Consensus Conference.
3. ED symptoms precede clinically evident CVD by as long as 2 to 5 years.
4. ED management in patients taking nitrate-containing medications or substances.
5. Drug–drug interactions and CV safety of PDE5 inhibitors( real-world observation data) .
6. PDE5 inhibitors may have cardioprotective effects and might play a role in preventative cardiology in the future.
Boyke SoebhaliIndonesia
Speaker
Updates on Pharmacological Therapy for UrolithiasisUrolithiasis, a prevalent and recurrent urological condition, requires a multifaceted approach combining pharmacological, dietary, and surgical interventions. Recent advancements in pharmacological therapy emphasize personalized treatment based on stone composition, metabolic profiles, and patient-specific risk factors.
For calcium oxalate stones, the most common type, thiazide diuretics remain first-line therapy to reduce urinary calcium excretion, while potassium citrate is recommended to increase urinary citrate levels, inhibiting stone formation. Dietary modifications, such as reduced oxalate intake and adequate calcium consumption, are adjunctive measures. In primary hyperoxaluria (PH), novel RNA interference (RNAi) agents like lumasiran and nedosiran significantly lower urinary oxalate levels, offering promising alternatives for patients unresponsive to pyridoxine.
Uric acid stones are managed with urinary alkalinization using potassium citrate or sodium bicarbonate to maintain a pH >6.0, enhancing uric acid solubility. Xanthine oxidase inhibitors (allopurinol, febuxostat) are reserved for hyperuricemic patients. Cystine stones, though rare, require alkalinization and thiol-based drugs (tiopronin) to improve cystine solubility.
Struvite stones, associated with urease-producing infections, necessitate antibiotics and urinary acidification (e.g., L-methionine) alongside surgical removal. Emerging therapies like theobromine show potential in inhibiting uric acid crystallization, while phytate demonstrates inhibitory effects on calcium salt aggregation.
Medical expulsive therapy (MET) with alpha-blockers (tamsulosin) remains effective for distal ureteral stones (5–10 mm), reducing time to expulsion and need for surgery. However, MET efficacy diminishes for proximal stones or those >10 mm, necessitating surgical intervention.
Future directions include optimizing RNAi therapies for hereditary stone diseases and integrating smartphone apps to enhance treatment adherence. A tailored, evidence-based approach combining pharmacological and lifestyle interventions is crucial for reducing recurrence and improving patient outcomes.Suction PCNL vs Suction RIRS? Do We Have a WinnerThe management of renal stones has evolved with the introduction of suction-assisted techniques in both percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). Suction PCNL, including mini-PCNL and flexible mini-PCNL (F-mPCNL), utilizes negative pressure to improve stone clearance and reduce intrarenal pressure, while suction RIRS employs vacuum-assisted ureteral access sheaths (V-UAS) or direct in-scope suction (DISS) to enhance fragment removal and minimize infectious complications.
Recent studies highlight that suction PCNL achieves superior stone-free rates (SFRs) in a single session, particularly for stones >2 cm, with SFRs ranging from 93.8% to 95.1% compared to 77.8%–87.9% for suction RIRS. However, suction RIRS offers advantages in reduced invasiveness, shorter hospital stays (1–3 days vs. 2–5 days for PCNL), and lower complication rates (e.g., bleeding, transfusion needs). For infectious stones, suction RIRS with V-UAS demonstrates lower postoperative infection markers (CRP, PCT) and fewer febrile complications than PCNL .
Operative times vary, with suction PCNL often being faster for large stones (47–82 min) but requiring fluoroscopy, while suction RIRS avoids tract-related risks but may necessitate staged procedures for stones >2 cm. Cost-effectiveness analyses favor suction PCNL due to fewer retreatments, though RIRS reduces radiation exposure.
-
-
Hung-Chieh ChiuTaiwan
Moderator
Erectile Dysfunction and Cardiovascular Health: Insights from the Updated Princeton Consensus1. PDE-5i exposure was associated with lower incidence of MACE, CV death, and overall mortality risk compared to non exposure and risk reduction correlated with PDE-5i exposure level.
2. Highlight of PDE5i and cardiac health in the 4th Princeton Consensus Conference.
3. ED symptoms precede clinically evident CVD by as long as 2 to 5 years.
4. ED management in patients taking nitrate-containing medications or substances.
5. Drug–drug interactions and CV safety of PDE5 inhibitors( real-world observation data) .
6. PDE5 inhibitors may have cardioprotective effects and might play a role in preventative cardiology in the future.
-
-
Hung-Chieh ChiuTaiwan
Speaker
Erectile Dysfunction and Cardiovascular Health: Insights from the Updated Princeton Consensus1. PDE-5i exposure was associated with lower incidence of MACE, CV death, and overall mortality risk compared to non exposure and risk reduction correlated with PDE-5i exposure level.
2. Highlight of PDE5i and cardiac health in the 4th Princeton Consensus Conference.
3. ED symptoms precede clinically evident CVD by as long as 2 to 5 years.
4. ED management in patients taking nitrate-containing medications or substances.
5. Drug–drug interactions and CV safety of PDE5 inhibitors( real-world observation data) .
6. PDE5 inhibitors may have cardioprotective effects and might play a role in preventative cardiology in the future.
Anil ShresthaNepal
Speaker
Clearpetra the Sheath of Choice for Lower Pole StonesSFR Assessment: Timing and Modalities
Boyke SoebhaliIndonesia
Speaker
Updates on Pharmacological Therapy for UrolithiasisUrolithiasis, a prevalent and recurrent urological condition, requires a multifaceted approach combining pharmacological, dietary, and surgical interventions. Recent advancements in pharmacological therapy emphasize personalized treatment based on stone composition, metabolic profiles, and patient-specific risk factors.
For calcium oxalate stones, the most common type, thiazide diuretics remain first-line therapy to reduce urinary calcium excretion, while potassium citrate is recommended to increase urinary citrate levels, inhibiting stone formation. Dietary modifications, such as reduced oxalate intake and adequate calcium consumption, are adjunctive measures. In primary hyperoxaluria (PH), novel RNA interference (RNAi) agents like lumasiran and nedosiran significantly lower urinary oxalate levels, offering promising alternatives for patients unresponsive to pyridoxine.
Uric acid stones are managed with urinary alkalinization using potassium citrate or sodium bicarbonate to maintain a pH >6.0, enhancing uric acid solubility. Xanthine oxidase inhibitors (allopurinol, febuxostat) are reserved for hyperuricemic patients. Cystine stones, though rare, require alkalinization and thiol-based drugs (tiopronin) to improve cystine solubility.
Struvite stones, associated with urease-producing infections, necessitate antibiotics and urinary acidification (e.g., L-methionine) alongside surgical removal. Emerging therapies like theobromine show potential in inhibiting uric acid crystallization, while phytate demonstrates inhibitory effects on calcium salt aggregation.
Medical expulsive therapy (MET) with alpha-blockers (tamsulosin) remains effective for distal ureteral stones (5–10 mm), reducing time to expulsion and need for surgery. However, MET efficacy diminishes for proximal stones or those >10 mm, necessitating surgical intervention.
Future directions include optimizing RNAi therapies for hereditary stone diseases and integrating smartphone apps to enhance treatment adherence. A tailored, evidence-based approach combining pharmacological and lifestyle interventions is crucial for reducing recurrence and improving patient outcomes.Suction PCNL vs Suction RIRS? Do We Have a WinnerThe management of renal stones has evolved with the introduction of suction-assisted techniques in both percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). Suction PCNL, including mini-PCNL and flexible mini-PCNL (F-mPCNL), utilizes negative pressure to improve stone clearance and reduce intrarenal pressure, while suction RIRS employs vacuum-assisted ureteral access sheaths (V-UAS) or direct in-scope suction (DISS) to enhance fragment removal and minimize infectious complications.
Recent studies highlight that suction PCNL achieves superior stone-free rates (SFRs) in a single session, particularly for stones >2 cm, with SFRs ranging from 93.8% to 95.1% compared to 77.8%–87.9% for suction RIRS. However, suction RIRS offers advantages in reduced invasiveness, shorter hospital stays (1–3 days vs. 2–5 days for PCNL), and lower complication rates (e.g., bleeding, transfusion needs). For infectious stones, suction RIRS with V-UAS demonstrates lower postoperative infection markers (CRP, PCT) and fewer febrile complications than PCNL .
Operative times vary, with suction PCNL often being faster for large stones (47–82 min) but requiring fluoroscopy, while suction RIRS avoids tract-related risks but may necessitate staged procedures for stones >2 cm. Cost-effectiveness analyses favor suction PCNL due to fewer retreatments, though RIRS reduces radiation exposure.
-
Hung-Chieh ChiuTaiwan
Speaker
Erectile Dysfunction and Cardiovascular Health: Insights from the Updated Princeton Consensus1. PDE-5i exposure was associated with lower incidence of MACE, CV death, and overall mortality risk compared to non exposure and risk reduction correlated with PDE-5i exposure level.
2. Highlight of PDE5i and cardiac health in the 4th Princeton Consensus Conference.
3. ED symptoms precede clinically evident CVD by as long as 2 to 5 years.
4. ED management in patients taking nitrate-containing medications or substances.
5. Drug–drug interactions and CV safety of PDE5 inhibitors( real-world observation data) .
6. PDE5 inhibitors may have cardioprotective effects and might play a role in preventative cardiology in the future.
Anil ShresthaNepal
Speaker
Clearpetra the Sheath of Choice for Lower Pole StonesSFR Assessment: Timing and Modalities
Boyke SoebhaliIndonesia
Speaker
Updates on Pharmacological Therapy for UrolithiasisUrolithiasis, a prevalent and recurrent urological condition, requires a multifaceted approach combining pharmacological, dietary, and surgical interventions. Recent advancements in pharmacological therapy emphasize personalized treatment based on stone composition, metabolic profiles, and patient-specific risk factors.
For calcium oxalate stones, the most common type, thiazide diuretics remain first-line therapy to reduce urinary calcium excretion, while potassium citrate is recommended to increase urinary citrate levels, inhibiting stone formation. Dietary modifications, such as reduced oxalate intake and adequate calcium consumption, are adjunctive measures. In primary hyperoxaluria (PH), novel RNA interference (RNAi) agents like lumasiran and nedosiran significantly lower urinary oxalate levels, offering promising alternatives for patients unresponsive to pyridoxine.
Uric acid stones are managed with urinary alkalinization using potassium citrate or sodium bicarbonate to maintain a pH >6.0, enhancing uric acid solubility. Xanthine oxidase inhibitors (allopurinol, febuxostat) are reserved for hyperuricemic patients. Cystine stones, though rare, require alkalinization and thiol-based drugs (tiopronin) to improve cystine solubility.
Struvite stones, associated with urease-producing infections, necessitate antibiotics and urinary acidification (e.g., L-methionine) alongside surgical removal. Emerging therapies like theobromine show potential in inhibiting uric acid crystallization, while phytate demonstrates inhibitory effects on calcium salt aggregation.
Medical expulsive therapy (MET) with alpha-blockers (tamsulosin) remains effective for distal ureteral stones (5–10 mm), reducing time to expulsion and need for surgery. However, MET efficacy diminishes for proximal stones or those >10 mm, necessitating surgical intervention.
Future directions include optimizing RNAi therapies for hereditary stone diseases and integrating smartphone apps to enhance treatment adherence. A tailored, evidence-based approach combining pharmacological and lifestyle interventions is crucial for reducing recurrence and improving patient outcomes.Suction PCNL vs Suction RIRS? Do We Have a WinnerThe management of renal stones has evolved with the introduction of suction-assisted techniques in both percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). Suction PCNL, including mini-PCNL and flexible mini-PCNL (F-mPCNL), utilizes negative pressure to improve stone clearance and reduce intrarenal pressure, while suction RIRS employs vacuum-assisted ureteral access sheaths (V-UAS) or direct in-scope suction (DISS) to enhance fragment removal and minimize infectious complications.
Recent studies highlight that suction PCNL achieves superior stone-free rates (SFRs) in a single session, particularly for stones >2 cm, with SFRs ranging from 93.8% to 95.1% compared to 77.8%–87.9% for suction RIRS. However, suction RIRS offers advantages in reduced invasiveness, shorter hospital stays (1–3 days vs. 2–5 days for PCNL), and lower complication rates (e.g., bleeding, transfusion needs). For infectious stones, suction RIRS with V-UAS demonstrates lower postoperative infection markers (CRP, PCT) and fewer febrile complications than PCNL .
Operative times vary, with suction PCNL often being faster for large stones (47–82 min) but requiring fluoroscopy, while suction RIRS avoids tract-related risks but may necessitate staged procedures for stones >2 cm. Cost-effectiveness analyses favor suction PCNL due to fewer retreatments, though RIRS reduces radiation exposure.
TWTC - 2F Conference Room A+
|
|
|
|
|
15:00
15:30
|
TWTC - 1F Exhibition Hall
|
|
15:30
17:00
|
-
Siros JitpraphaiThailand
Speaker
RCC and IVC ThrombectomyRCC and IVC thrombus
Siros Jitpraphai
Division of Urology, Department of Surgery,
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, THAILAND
Abstract
Renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus represents a complex surgical challenge, with an incidence of venous involvement in 4-10% of cases. This case report demonstrates the successful surgical management of a 58-year-old female patient with a large left-sided renal mass and IVC thrombus. The patient presented with gross hematuria and was diagnosed with a 10 cm clear cell renal cell carcinoma (Fuhrman nuclear grade 3) extending into the renal vein and IVC. Recognizing the complexity of the case, a multidisciplinary approach was employed, involving urological and hepatobiliary surgical teams. The comprehensive treatment strategy included an open radical nephrectomy with IVC thrombectomy. The surgical technique was meticulously planned and executed, with several key considerations. Preoperative imaging was crucial in determining the exact level of thrombus, allowing for precise surgical planning. The procedure emphasized careful vascular control and en-bloc tumor removal, with intraoperative ultrasound used to ensure accurate thrombus localization. Surgical teams worked collaboratively to minimize potential complications and maximize surgical success. Operatively, the procedure was substantial, with an estimated blood loss of 900 mL and a total operative time of 5 hours. The patient required two days of postoperative intensive care and was discharged from the hospital seven days after the surgery. Pathological examination confirmed the diagnosis of clear cell renal cell carcinoma, with no lymph node metastasis detected and positive tumor thrombus. Importantly, surgical margins were found to be free of tumor.
Follow-up evaluations have been encouraging, with no signs of tumor recurrence observed during regular intervals. This case illustrates the critical importance of a systematic surgical approach, precise technical execution, and comprehensive multidisciplinary management in successfully treating RCC with IVC thrombus. It provides valuable insights into the complex surgical management of this challenging condition, potentially offering guidance for similar cases in the future.
Keyword: RCC (Renal Cell Carcinoma), IVC Thrombus, Thrombectomy, Surgical Technique, Multidisciplinary Management
Highlight: RCC with IVC thrombus is a complex surgical challenge affecting 4-10% of cases. Successful management requires meticulous preoperative imaging, multidisciplinary team approach, and precise surgical technique. With careful planning and execution, 45-70% of patients can be cured through radical nephrectomy and IVC thrombectomy.
Robotic Partial Nephrectomy in Complex and Difficult Tumor Location
-
Surya Prakash VaddiIndia
Speaker
Cytoreductive Nephrectomy in the Era of Immune TherapyRobotic Partial Nephrectomy in Tumors with High Renal Score
-
John YuenSingapore
Moderator
Technical Pearls: Total Extraperitoneal TechniquePractice-Changing Development in RaLRP
Andrew Kennedy SmithNew Zealand
Speaker
Zero Ischemia Laparoscopic Partial NephrectomyNephron preservation with complete tumour excision and without complications remain the goals of surgery for early-stage kidney tumours. This surgery remains technically challenging using a minimally invasive platform, and there remain variations of technique. We present what is now an established approach within our centre, but has been enhanced by progressive improvements in the specific surgical instrumentation. The technique is achievable in a smaller centre with lower surgical volumes. We perform a laparoscopic partial nephrectomy using waterjet and advanced bipolar energy without vascular clamping and without renorrhaphy, supplemented with topical hemostatic agents, reliably achieving the stated goals of this surgery.
Ischaemia and delayed complications are minimised by avoiding renorrhaphy and vascular clamping during dissection.Zero Ischemia Laparoscopic Partial Nephrectomy for Hilar TumorsOur technique for hilar tumours remains similar to that for peripheral tumours, again using waterjet and advanced bipolar energy without vascular clamping and without renorrhaphy, supplemented with topical hemostatic agents. Waterjet may be safely used directly on major vessels and collecting system structures, and directly on the tumour capsule, to perform either conventional partial nephrectomy with parenchymal margin or tumour enucleation. With hilar dissection, it is possible to visualise and control arterial supply directly to the tumour, reducing the potential for blood loss.
The stated goals of this surgery are achieved. The technique which avoids renorrhaphy is particularly relevant in hilar tumours where renorrhaphy may not be technically achievable.
-
Andrew Kennedy SmithNew Zealand
Speaker
Zero Ischemia Laparoscopic Partial NephrectomyNephron preservation with complete tumour excision and without complications remain the goals of surgery for early-stage kidney tumours. This surgery remains technically challenging using a minimally invasive platform, and there remain variations of technique. We present what is now an established approach within our centre, but has been enhanced by progressive improvements in the specific surgical instrumentation. The technique is achievable in a smaller centre with lower surgical volumes. We perform a laparoscopic partial nephrectomy using waterjet and advanced bipolar energy without vascular clamping and without renorrhaphy, supplemented with topical hemostatic agents, reliably achieving the stated goals of this surgery.
Ischaemia and delayed complications are minimised by avoiding renorrhaphy and vascular clamping during dissection.Zero Ischemia Laparoscopic Partial Nephrectomy for Hilar TumorsOur technique for hilar tumours remains similar to that for peripheral tumours, again using waterjet and advanced bipolar energy without vascular clamping and without renorrhaphy, supplemented with topical hemostatic agents. Waterjet may be safely used directly on major vessels and collecting system structures, and directly on the tumour capsule, to perform either conventional partial nephrectomy with parenchymal margin or tumour enucleation. With hilar dissection, it is possible to visualise and control arterial supply directly to the tumour, reducing the potential for blood loss.
The stated goals of this surgery are achieved. The technique which avoids renorrhaphy is particularly relevant in hilar tumours where renorrhaphy may not be technically achievable.
-
Arnulf StenzlGermany
Speaker
EAU Lecture: AI to Support Informed Decision Making (INSIDE) for Improved Literature Analysis in Oncology.Robot-Assisted Radical Cystectomy and Intracorporeal Neobladder Formation
-
TICC - 3F Plenary Hall
|
Meet the Future: Urology Fellowship Opportunities
-
Eddie ChanHong Kong, China
Speaker
How to Escape Surgical ComplicationsSurgical complications can significantly impact patient outcomes and healthcare resources. This talk will focus on practical strategies to minimize complications in urologic surgery, tailored specifically for urology fellows. Real-life case examples will illustrate how thoughtful preparation and proactive communication can prevent or mitigate complications. Additionally, we will discuss structured approaches to managing complications when they arise, including communication with the patient and team, documentation, and timely intervention. Through real-life case examples, this session aims to enhance surgical judgment, promote patient safety, and build confidence in complication management.
-
Chi-Hang YeeHong Kong, China
Speaker
Robotic Total Intracorporeal Urinary Diversion – from Ileal Conduit to Neobladder to Ileal Interposition Prostate Cancer Focal Therapy: Ready for Prime Time?
-
-
Hung-Jen WangTaiwan
Speaker
Technical Pearls: Nerve-SparingPreserving the neurovascular bundles (NVB) during robotic-assisted radical prostatectomy (RARP) is crucial for maintaining postoperative continence and sexual function, while still ensuring complete cancer removal. We will share "technical pearls" for nerve-sparing in RARP, emphasizing practical innovations that enhance surgical precision without compromising oncologic control.
Retrograde nerve-sparing involves a bottom-up (apex-to-base) dissection of the NVB using an athermal, gentle approach. This technique, adapted from open surgery, allows early identification and release of the nerves under direct vision. By minimizing traction and avoiding cautery near the NVB, it reduces inadvertent nerve injury and even lowers the risk of positive margins at the prostatic base. Clinically, adopting a retrograde approach (often with 30° lens “toggling”) has been linked to faster functional recovery of potency, contributing to potency rates approaching 90% at 1 year in fully nerve-sparing cases.
Parallel advances in augmented reality (AR) are providing real-time surgical navigation. AR technology superimposes 3D virtual models (e.g. from MRI) onto the operative field, enhancing visualization of patient-specific anatomy. Surgeons can pinpoint tumor location relative to the NVB, enabling selective, confidence-guided nerve preservation even in locally advanced disease. This approach helps modulate nerve-sparing extent on a case-by-case basis, maintaining oncologic safety (low positive surgical margin rates) while maximizing nerve preservation.
Finally, refined anatomical landmarks have emerged to guide nerve-sparing. A notable example is the identification of a consistent small arterial branch (“landmark artery”) at the NVB’s medial aspect. This vessel serves as a guide for partial nerve-sparing: dissecting just lateral to it yields an approximate 3 mm tissue margin from the prostatic capsule, sufficient to clear potential extracapsular extension while preserving the remaining nerve fibers. Such landmark-oriented dissection provides a reproducible framework for tailoring nerve-sparing to tumor risk, moving beyond the traditional “all-or-none” approach.
These advanced techniques and concepts are empowering robotic surgeons to achieve optimal outcomes. By integrating retrograde nerve-sparing, AR-assisted navigation, and anatomical landmark guidance, one can improve early continence recovery and postoperative sexual function for patients without sacrificing cancer control.
-
TICC - 3F Banquet Hall
|
Prostate Cancer
-
Lui Shiong LeeSingapore
Moderator
Technical Pearls: Robotic Intra-Corporeal OBSThis session will demonstrate the key steps required in the intra-corporeal creation of a Studer type orthotropic bladder substitute.
-
Peter Ka-Fung ChiuHong Kong, China
Speaker
Minimal Invasive Therapy: Where do We Stand in 2025Endourological, Laparoscopic and robotic surgeries have replaced most open surgeries in Urology. Emergence of new robotic platforms have provided urologists with new opportunities. Both boom-type and module-type robots have been used, and they each have their strengths in practice. Tele-surgeries have provided a new paradigm of long-distance robotic surgeries to facilitate new surgical possibilities and proctorship. State of the art robotic surgeries in retrograde intrarenal surgeries and enbloc resection MDT Discussion: Personalizing Treatment in High Volume CSPCN/ADebate: Should We Only Offer Consolidative Cytoreductive Nephrectomy in Metastatic RCC?N/AFocal Therapy in Asia – Is It Prime Time?The increase in incidence of Prostate cancer has been rapid in Asia in the past 10 years. While Robotic radical prostatectomy and Radiotherapy has been the commonest treatments for localized prostate cancer, significant long-term morbidities are observed after surgery or radiotherapy including incontinence, erectile dysfunction and irradiation injury to the bladder and rectum. In the current era of MRI-guided prostate biopsy, focal diseases can be targeted and diagnosed, and image-guided focal therapy emerged as an alternative treatment. Although Focal therapy has a relatively higher rate of local recurrence, it has the advantages of minimal or no long-term complication after treatment, and it is possible to perform retreatment with focal therapy, prostatectomy or radiotherapy. In properly selected patients, the need for salvage prostatectomy or radiotherapy after focal therapy is less than 20% at 8 years, and patients’ quality of life could be preserved. In well-selected patients, focal therapy is an attractive option. Current focal therapy for prostate cancer available in Asia includes HIFU, Cryotherapy, Targeted Microwave Ablation (TMA), irreversible electroporation (IRE) and TULSA.
-
-
Stephen A. BoorjianUnited States
Speaker
AUA Lecture: 2025 Update of AUA and EAU NMIBC GuidelinesBoth the American Urological Association (AUA) and European Association of Urology (EAU) have developed guidelines for the management of non-muscle invasive bladder cancer (NMIBC). While subtle differences in several aspects of these guidelines exist which merit mentioning, both guidelines emphasis the concept of risk stratification. In particular, understanding the criteria which classifies patients with NMIBC as high risk avoids undertreatment of the patients most likely to experience disease progress. Likewise, recognizing the indications for cystectomy among high risk NMIBC patients is critical to optimize survival. Meanwhile, continued options emerge for patients classified as having BCG unresponsive NMIBC, such that knowledge of that definition as well as current management strategies for these patients facilitates contemporary practice.From Bench to Bedside - A Comprehensive Overview of Kidney CancerEvaluation of patients with a newly identified renal mass includes dedicated cross-sectional imaging for appropriate characterization. Genetic syndromes which include renal cell carcinoma (RCC) are increasingly understood, and indeed knowledge of the intracellular pathways of these conditions has facilitate rationale drug development for kidney cancer. Managing patients with a small renal mass involves a critical assessment of competing risks inherent to the tumor, the patient (underlying comorbidity status), and the proposed treatment. Renal mass biopsy may play a role in select cases for additional information/risk stratification. The safety of active surveillance is being increasingly demonstrated as longer-term follow-up matures. Meanwhile, select patients with high risk disease now have the option of adjuvant immunotherapy following surgical resection. In the setting of metastatic RCC, again risk stratification plays a critical role in the decision for – and timing of – cytoreductive nephrectomy, particularly in the contemporary era of checkpoint inhibitor therapies.Real World Experience in the Management of Upper Tract Urothelial CarcinomaThe biggest challenging in managing upper tract urothelial carcionma (UTUC) remains accurate staging of tumors at diagnosis. Given the limited ability of contemporary staging methods, clinical risk stratification models have been developed to assist in providing risk-based treatment recommendations. For example, endoscopic management (e.g., ablation) represents the recommended first line approach for patients with low risk disease. Importantly, follow-up for these patients should include endoscopic re-evaluation. The value of testing patients with UTUC for Lynch syndrome is also critical to recognize. A role for neoadjuvant chemotherapy is being increasing explored for patients classified with high-risk UTUC, while several options exist for adjuvant chemotherapy and immunotherapy for patients with adverse pathology at surgical resection. Continued investigation into prevention of postoperative intravesical recurrences in patients with UTUC is warranted given the frequency of metachronous tumor development in the bladder among these patients.Updates on MIBC and Advanced Bladder Cancer: Where do We Stand in 2025While neoadjuvant chemotherapy prior to radical cystectomy has been demonstrated with randomized trial data to improve survival for patients undergoing radical cystectomy, nevertheless utilization is often restricted by misunderstandings regarding patient eligibility factors. As such, defining eligibility criteria will facilitate increased adoption. Likewise, new data indicates a role for adjust immunotherapy in select patients following surgery as well. Moreover, important recent evidence on the role of extended lymph node dissection and the opportunities for preserving sexual function after cystectomy by modifying surgical technique are critical to review in order to optimize future patient outcomes. Further, recent advancements in systemic therapy options for patients with metastatic urothelial carcinoma have led to unprecedented survival rates.Revisit on Testicular Tumors-What we Learned from past and Prepared for the FutureGerm cell tumor (GCT) progression typically occurs in a predictable sequence of disease spread to the retroperitoneum first and then distant metastases. Understanding the role of serum tumor markers at various disease stages is critical for guideline-concordant management and to optimize patient outcomes, avoiding both undertreatment and overtreatment. For patients with seminoma, retroperitoneal lymph node dissection now represents an option for patients with low volume retroperitoneal lymph node disease, with the goal of avoiding the long-term toxicities associated with chemotherapy and radiotherapy. For patients with residual postchemotherapy masses in seminoma, increasing evidence suggests that PET scans should be utilized/interpreted with caution, and that in the absence of mass growth continued follow-up may be the strategy for most patients. Similarly, for patients with nonseminomatous GCTs (NSGCT) and equivocal retroperitoneal lymph nodes at presentation, re-scanning after an interval of approximately 6-8 weeks may be preferable to initial treatment, as many of these nodes represent benign processes and as such will resolve. Nevertheless, postchemotherapy retroperitoneal lymph node dissection remains a critical component of the management of patients with NSCGT and a residual mass. Risk Stratification and Contemporary Management of Biochemical RecurrenceBiochemical recurrence (BCR) has been reported in up to 35% of patients following radical prostatectomy. Understanding the natural history and clinicopathologic risk factors associated with disease progression is critical to facilitate an individualized treatment approach. Likewise, recognizing the details of treatment delivery with salvage radiotherapy is necessary to optimize outcomes. Further, as data emerge on the utilization of systemic therapy for non-metastatic BCR, being able to contextualize reported outcomes with patient age, comorbidity status, and disease risk will enhance appropriate care delivery.
-
Ching-Chu LuTaiwan
Speaker
The Strategy to Initiate PSMA-Based Therapies for Advanced Prostate CancerPSMA-targeted radioligand therapy (PSMA RLT) has emerged as a promising treatment for metastatic castration-resistant prostate cancer (mCRPC), particularly after failure of androgen deprivation therapy, next-generation hormonal agents, and chemotherapy. While PSMA RLT is currently a third-line treatment, evidence from the PSMAfore trial suggests its potential efficacy when used earlier in the treatment sequence, prior to chemotherapy, offering a new strategy for improving progression-free survival (PFS) in mCRPC patients.
In addition, PSMA RLT is being explored in metastatic hormone-sensitive prostate cancer (mHSPC), with ongoing trials such as PSMAddition, investigating its role in delaying disease progression and improving patient outcomes when combined with standard therapies.
Moreover, PSMA RLT is being evaluated in combination with other treatments, including PARP inhibitors, immunotherapy, chemotherapy, and radiation therapy. Numerous ongoing trials are exploring these combination therapies to further enhance the therapeutic efficacy of PSMA RLT and improve patient outcomes in advanced prostate cancer.
Novel radionuclides such as Actinium-225 (Ac-225) and Terbium-161 (Tb-161) are being investigated for their potential to improve the therapeutic profile of PSMA RLT. These isotopes offer unique advantages, including different radiation characteristics that could increase the efficacy and safety of PSMA-targeted therapies.
In conclusion, PSMA RLT is becoming a cornerstone of precision oncology for prostate cancer. As research continues to explore its use earlier in the treatment continuum, in combination with other therapies, and with the incorporation of novel radionuclides, PSMA RLT holds great promise for improving outcomes in advanced prostate cancer patients.
-
TICC - 2F 201BC
|
Management of Post-Prostatectomy Incontinence
-
Hann-Chorng KuoTaiwan
Moderator
ACU Lecture: Videourodynamic Study for Precision Diagnosis and Management of Lower Urinary Tract DysfunctionVideourodynamic Study in the Precision Diagnosis and Management of Lower Urinary Tract Dysfunctions
Hann-Chorng Kuo, M.D.
Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan
As a urologist, we are dealing with patients with lower urinary tract symptoms everyday. We did transurethral resection of the prostate (TURP) for elderly men with bothersome lower urinary tract symptoms (LUTS). We put a suburethral sling for women with stress urinary incontinence (SUI). We prescribed alpha-blocker for those who had difficulty in urination. We add antimuscarinics for patients with urgency urinary incontinence. Our seniors always told us these treatments are effective in treating patients with LUTS. However, patients still had LUTS after TURP, women still complained of urgency and dysuria after anti-incontinence surgery. Medication based on storage or emptying LUTS do not work all the time. Why? Because symptoms are not reliable, a large prostate does not indicate bladder outlet obstruction (BOO), and SUI is not solely a result of urethral incompetence. Therefore, in diagnosis and management of LUTS, we need precision medicine to direct an accurate pathophysiology of LUTS, and to guide an appropriate management based on the bladder and bladder outlet dysfunction. When we encounter patients who have LUTS refractory to the treatment based on our initial diagnosis, when we are treating patients who have complicated storage and emptying LUTS, when we are not sure patients could benefit from the invasive procedures for their LUTS, or patients who had both lower and upper urinary tract dysfunctions, videourodynamic study (VUDS) is an essential investigation for diagnosis and management of LUTS. In additional to benign prostate hyperplasia (BPH) and BOO, male patients with emptying LUTS might result from detrusor underactivity (DU), bladder neck dysfunction (BND), urethral sphincter dysfunction, or a hypersensitive bladder, which is not related with the prostate. Patients with BPH and LUTS might have latent neurogenic lesion, such as minor stroke, Parkinson's disease, or early dementia, causing LUTS. TURP without known the neurological disease might exacerbate LUTS after surgery. Mixed SUI comprises intrinsic sphincter deficiency (ISD) and detrusor overactivity (DO). The overactive bladder (OAB) symptoms may also result from an incompetent bladder outlet. Without comprehensive VUDS, we might cure the SUI, but OAB remains after placing a mid-urethral sling. Bladder pain is the cardinal symptoms of interstitial cystitis. However, bladder pain perceived by the patient might also originate from BOO or pelvic floor fascitis. VUDS can help in discrimination. DU and low compliant bladder and ISD could result in complicated storage and emptying LUTS. Large post-void residual (PVR) should alert us to investigate whether it is originated from low compliance or ISD. Dysfunctional voiding (DV) and BND in women with emptying LUTS. OAB symptoms are not always coming from the DO. BOO such as BND, DV, or urethral stricture might exist in men and women without voiding symptoms. Urinary difficulty in women is usually a result from low detrusor contractility, due to DU, or through inhibitory effect from a poorly relaxed pelvic floor or urethral sphincter. A simple bladder neck incision can effectively restore spontaneous voiding in men or women with dysuria due to DU or BND. However, a tight BN is necessary to predict a successful treatment outcome. Patients with central nervous system (CNS) disorders or spinal cord injury usually have complicated LUTD, including DO, BND, DV, detrusor sphincter dyssynergia (DSD), and vesicoureteral reflux (VUR). Management of LUTS in CNS disorders or SCI patients should know the current bladder and bladder outlet dysfunctions. Pediatric incontinence, children with myelomeningocele, DV, or recurrent urinary tract infection are complicated and need precision diagnosis before treatment. Especially when surgery is planned. Lower urinary tract dysfunctions is a dynamic condition. The bladder and bladder outlet dysfunction might change with time. Although VUDS is considered as an invasive investigation with radiation exposure, the advantages in accurate diagnosis and guiding management outweigh these disadvantages.
-
Lewis ChanAustralia
Speaker
Imaging of Male Pelvic Floor Structure and the Natural Course of Pelvic Floor Remodeling after ProstatectomyLower urinary tract symptoms and incontinence are common issues in the ageing population. It is well recognised that radical prostatectomy can have significant impact on urinary continence and quality of life in men who have undergone surgery for prostate cancer. The causes of post prostatectomy incontinence can be multifactorial and urodynamic studies in men prior to prostatectomy have shown a high prevalence of bladder dysfunction. This presentation covers the role of dynamic ultrasound in studying the male pelvic floor and the changes observed following prostatectomy.
-
Yen-Chuan OuTaiwan
Speaker
ARUS–PRUS Partnership Ceremony: A New Chapter in Asia Robotic Urology CollaborationDear colleagues and friends,
It’s a great honor to witness the signing of this partnership between the Asian Robotic Urology Society (ARUS) and the Philippines Robotic Urology Society (PRUS).
This marks the beginning of a new chapter in regional collaboration—one that emphasizes shared training, joint research, and mutual support to advance robotic urology across Asia. PRUS brings energy, expertise, and vision to this partnership, and ARUS is proud to walk alongside you as we work toward higher standards and better outcomes for our patients. Let us move forward together—with unity, purpose, and innovation.
Congratulations to both ARUS and PRUS!Aquablation Revolutionizing BPH Treatment: A New Era of Minimally Invasive Therapy-Tungs' Taichung Metroharbor Hospital ExperienceIntroduction
Aquablation is a waterjet ablation therapy for benign prostatic hyperplasia (BPH) that has gained significant attention. While its efficacy, durability, and safety have been established across various prostate sizes (30–150 mL), local data on its efficacy, safety, and learning curve in Taiwan remain limited. Our team have been performed 85 cases between March 2024 and July 2025. This lecture presents the learning curve observed in the first 50 patients who underwent Aquablation for BPH, highlighting its role in revolutionizing BPH treatment.
Materials and Methods
We conducted a retrospective review of 50 consecutive patients who underwent Aquablation between March 2024 and February 2025, dividing them into two groups: Group I (first 25 cases) and Group II (subsequent 25 cases). Assessments included IPSS, QoL, uroflowmetry parameters (voiding volume, Qmax, Qmean, PVR), operative time, hemoglobin drop, Clavien-Dindo grade ≥2 complications, hospital stay, and urethral catheter duration.
Results
Patients in Group II were younger and had smaller prostates. Aquablation was successfully performed in all cases. IPSS, QoL, voiding volume, Qmax, and Qmean improved significantly and were sustained for three months, while PVR improved only in Group I. Operative time was significantly shorter in Group II, and hemoglobin drop was greater in Group I. Complication rates, hospital stay, and catheter duration were similar between groups.
Conclusions
Aquablation provided significant and immediate improvements in voiding parameters and symptoms, with sustained PVR benefits in larger prostates. Surgeon proficiency improved after 25 cases. Overall, Aquablation proved safe and effective, even in an unselected patient population. Aquablation represents a promising advancement that could transform the therapeutic landscape for BPH—particularly if costs are reduced.Experience of 100 Consecutive Hugo Robotic Radical ProstatectomiesIntroduction and background:
Dr. Ou’ surgical team of Tungs’ Taichung MetroHarbor Hospital performed the first Hugo robotic radical prostatectomy on May 9, 2023. In 2023, we published the results of the first series of 12 Hugo robotic radical prostatectomies performed. In 2024, we published a comparison of 30 Hugo robotic radical prostatectomies and 30 Da Vinci robotic radical prostatectomies. Professor Ou is the Hugo robotic arm instructor recognized by Medtronic. Many Southeast Asian doctors come to this Hospital to observe the surgery and learn.
Material and Methods:
We prospectively collected data for retrospective analysis and statistics from May 9, 2023 to April 30, 2025, performing 100 consecutive Hugo robotic radical prostatectomies. We compared the surgical results of 1-50 cases (group 1) and 51-100 cases (group 2). The data analyzed included basic information, age, risk of anesthesia, BMI , prostate-specific antigen, clinical stage, and Gleason score grade. The two groups were compared in terms of surgical difficulty, receipt of neoadjuvant hormonal therapy, obesity, prostate volume >70 g, prostate protrusion more than 1 cm into the bladder neck, previous transurethral resection of prostate, history of abdominal surgery, extensive pelvic lymphadenectomy, salvage radical prostatectomy, and time from biopsy to radical prostatectomy less than 6 weeks. The two groups were compared in terms of robotic console time, blood loss, blood transfusion rate, and surgical complications. We compared the two groups in terms of postoperative pathological staging and grade, the proportion of tumor, and the proportion of urinary control at one month and three months.
Results:
The study showed that the age of patients in the second group was slightly higher, but the statistical p value was 0.058, which did not reach statistical difference. The second group of patients had significantly higher rates of stage III, stage IV, lymph node and bone oligometastasis, with a p value of 0.021. The rate of neoadjuvant hormonal therapy received by the second group was 16 percent, which was statistically significant compared with 2 percent of the first group (p = 0.021). The rates of other surgical difficulty factors were the same between the two groups. The average blood loss of patients in the second group was 156 CC, which was significantly less than the 208 CC in the first group. The operation time and surgical complications were comparable between the two groups. The cancer volume of the second group of patients was significantly reduced compared with that of the first group (3.30±2.93 versus 5.09±5.24, p value=0.049). The reason was that more patients in the second group received neoadjuvant hormonal therapy, which significantly reduced the cancer. Both groups of patients had very good urinary control after surgery.
Conclusion:
We conclude that Hugo robotic radical prostatectomy is an effective and feasible method with extremely low complications and good recovery of urinary control function after surgery. After the experience of the first 50 operations, the surgeon will choose patients with higher difficulty, especially those receiving neoadjuvant hormone therapy, to perform the operation.Total Solution of Maintenance of Urinary and Sex Function during Robotic Radical ProstatectomyBackground:
Robotic-assisted radical prostatectomy (RARP) has become a preferred surgical approach for localized prostate cancer due to its minimally invasive nature and precision. However, the preservation of urinary continence and sexual function remains a significant postoperative challenge. Traditional outcomes have focused heavily on oncological safety. Yet, contemporary perspectives emphasize a more holistic view—embodied in the concept of the “Pentafecta,” which includes continence, potency, negative surgical margins, biochemical recurrence-free survival, and absence of perioperative complications.
Objective:
This presentation introduces a comprehensive and integrative approach aimed at maximizing functional outcomes—particularly urinary continence and erectile function—through a modified pubovesical complex-sparing RARP under regional hypothermia, supplemented with real-time nerve imaging, neurovascular preservation strategies, and biological enhancement techniques.
Methods:
We present data and experience from Tungs’ Taichung MetroHarbor Hospital (TTMHH), including a series of 3780 robotic procedures performed between December 2005 and July 2025. Among these, 100 cases were completed using the Hugo™ RAS system and 21 with the da Vinci SP™ platform. Our modified technique builds upon Dr. Richard Gaston’s pubovesical complex-sparing method, with the addition of localized hypothermia (24°C), near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG), and application of dehydrated human amnion/chorion membrane (dHACM). In selected cases, nerve grafting with Axogen® technology was applied.
Results:
Initial results indicate a significantly improved early return of continence (95% by 16 weeks) and promising erectile function recovery, particularly in patients who received adjunctive therapies such as phosphodiesterase inhibitors or vacuum erection devices. The precision afforded by robotic technology enabled preservation of
prostate capsular arteries and accessory pudendal arteries. Localized hypothermia contributed to reduced tissue edema, minimized neural trauma, and improved nerve recovery. The use of ICG-NIRF allowed real-time identification of critical vascular landmarks, enhancing nerve-sparing accuracy. Preliminary analysis suggests our technique is both feasible and reproducible.
Conclusion:
The modified pubovesical complex-sparing RARP under hypothermia, augmented with vascular imaging and biologic materials, offers a promising paradigm for functional preservation in prostate cancer surgery. This total solution approach not only protects neurovascular integrity but also accelerates recovery of continence and potency.
Continued accumulation of clinical cases and controlled comparative studies are warranted to further validate the efficacy and long-term benefits of these techniques.
Significance:
This strategy reflects a patient-centered evolution in robotic prostate surgery, merging surgical innovation with anatomical preservation and technological augmentation. It represents an epic collaboration of surgical precision, team-based care, and thoughtful application of biomedical advances to improve quality of life outcomes in prostate
cancer patients.Total Solution of Maintenance of Urinary and Sex Function during Robotic Radical Prostatectomy
-
Chung-Cheng WangTaiwan
Speaker
Ureteral Stent and SelectionUreteral stents are widely used in urology for the management of obstructive uropathies, including urologic or non-urologic malignancy, radiation therapy, ureteral calculus, infection, surgical or nonsurgical trauma, or congenital factors. An untreated ureteral obstruction could result in urinary tract infection, abdominal or flank pain, and a deterioration of renal function. Despite their widespread utility, the selection of an appropriate ureteral stent remains a complex clinical decision involving multiple variables including patient-specific factors, disease pathology, duration of stenting, and the desired balance between drainage efficacy and patient comfort.
Advancements in stent technology have led to the development of a variety of stent types, distinguished by their material composition (e.g., polyurethane, silicone, and hydrophilic-coated polymers), design features (e.g., double-J, multi-length, tail stents), drug-eluting capabilities, reinforced metallic stent, and biodegradable stents. Each design aims to optimize certain aspects of performance such as resistance to encrustation, migration, infection, and stent-related symptoms.
Key considerations in stent selection include indwelling time, risk of infection or encrustation, patient anatomy, and comorbidities or prior urologic surgery. For short-term use, polyurethane or co-polymer stents are often preferred due to their balance of flexibility and cost-effectiveness. In contrast, silicone stents may be more appropriate for long-term indwelling due to their superior biocompatibility and reduced encrustation rates. Drug-eluting stents are emerging as promising options in cases of recurrent infection or tumor-associated obstruction. Softer materials, tapered tips, and biodegradable stents aim to reduce stent-related lower urinary tract symptoms.
Recently, we reported the efficacy and safety of Allium metallic ureteral stents in treating 13 patients with refractory ureteral strictures. The median (IQR) age of the patients was 63 (46–76) years. The median (IQR) follow-up was 15 (13.5–21) months. Treatment success and improvement were noted in 9 (69.2%) and 3 (23.1%) patients, respectively. Compared to the preoperative levels, the median (IQR) serum creatinine levels were significantly improved at 3 months after the operation [1.6 (1.25–2.85) vs. 1.2 (1.05–2.05), p = 0.02] and at the last visit [1.6 (1.25–2.85) vs. 1.2 (1.05–1.8), p = 0.02]. Stent migration and encrustation were noted in three (23.1%) and one (7.7%) patients, respectively. The preliminary results showed that Allium ureteral stents were safe and effective for patients with refractory ureteral strictures.
In conclusion, as technology continues to evolve, the future of ureteral stenting lies in personalized device selection based on real-time patient feedback, predictive analytics, and enhanced biomaterials. Further clinical trials and comparative studies are essential to establish evidence-based guidelines that can assist clinicians in making the most appropriate stent choices for optimal outcomes
Fixed and Adjustable Male Slings: Key Techniques for Primary Implantation and Troubleshooting in Challenging CasesMale slings have emerged as an effective surgical solution for stress urinary incontinence (SUI) following radical prostatectomy, offering an alternative to artificial urinary sphincters, particularly in patients with mild to moderate incontinence. Among the available options, fixed and adjustable male slings represent two major categories, each with distinct mechanisms of action, implantation techniques, and postoperative management considerations.
Fixed male slings work by repositioning and compressing the bulbar urethra against the pubic ramus to restore continence. These slings rely on proper patient selection—typically individuals with preserved sphincter function, low-volume leakage, and no prior pelvic radiation. Key technical considerations include precise dissection of the perineal space, adequate urethral mobilization, tension-free sling placement, and symmetric anchoring of the arms. Avoidance of over-tensioning is crucial to prevent postoperative urinary retention and perineal discomfort.
Adjustable male slings offer intraoperative or postoperative modification of sling tension to accommodate varying degrees of incontinence or suboptimal initial outcomes. These slings are particularly useful in patients with higher degrees of incontinence, previous pelvic surgery, or radiation. The implantation techniques vary but generally involve positioning a cushion or compressive element under the urethra, with external or subcutaneous access ports for saline adjustment. Mastery of device calibration, port placement, and infection prevention are critical to long-term success.
Challenging cases—such as those involving prior sling failure, prior pelvic radiation, fibrosis, or altered anatomy—require tailored strategies. In irradiated patients, tissue integrity and healing potential are compromised, often necessitating the use of adjustable systems with minimal tissue dissection or the combination of sling and bulking agents. In reoperative fields, precise identification of tissue planes and modified dissection techniques are required to prevent urethral injury or inadequate compression. Troubleshooting sling failure involves assessing continence status, sling positioning via imaging or endoscopy, and determining whether revision, adjustment, or conversion to an artificial urinary sphincter is most appropriate.
Postoperative complications including infection, urethral erosion, urinary retention, and persistent incontinence can be mitigated by proper surgical technique, patient education, and regular follow-up. Management of these complications should be proactive and individualized, balancing intervention timing with patient expectations and functional goals. In this topic, we will share our experiences to avoid these complications and increase the successful outcome.
-
-
-
TICC - 2F 201DE
|
Recent Advancements in Pediatric Urology (II)
-
-
Li-Yi LimMalaysia
Speaker
Pediatric Urological SurgeryWhat’s New in Nocturnal Enuresis?
-
Sungchan ParkKorea (Republic of)
Speaker
What's New in Adolescent Varicocele?Varicocele is defined as an abnormal dilatation of testicular veins in the pampiniformis plexus caused by venous reflux. It is unusual in boys under ten years of age and becomes more frequent at the beginning of puberty. It is found in 14-20% of adolescents, with a similar incidence during adulthood. In 70% of patients with grade II and III varicocele, left testicular volume loss was found. Abnormal reproductive hormonal levels (increased serum levels of FSH and LH, and decreased levels of inhibin B) and semen quality were reported in varicocele patients and were directly related to varicocele severity. In about 20% of adolescents with varicocele, fertility problems will arise. The adverse influence of varicocele increases with time.
Surgical indications
1. The recommended indication criteria for varicocelectomy in children and adolescents
- varicocele associated with a small testis (volume difference > 20%)
This should be confirmed on two subsequent visits six months apart
2. Additional treatment can be considered on a case by case
- additional testicular condition affecting fertility
- bilateral palpable varicocele
- pathological sperm quality (in older adolescents)
- symptomatic varicocele (pain, 2-10%)
- cosmetic reasons related to scrotal swelling
- Repair of a large varicocele, causing physical or psychological discomfort, may also be considered.
--> Other varicoceles should be followed-up until a reliable sperm analysis can be performed.
Natural progression of testicular growth
Surgical treatment
Based on ligation or occlusion of the internal spermatic artery. Ligation is performed at different levels.
- inguinal (or subinguinal) approach with or without microsurgical or macroscopic (loupe) assistance
- suprainguinal ligation, using open or laparoscopic techniques (few report using robotic system)
- Sclerosing therapy using retrograde or antegrade approach.
For surgical ligation, some form of optical magnification (microscopic or laparoscopic) should be used because the internal spermatic artery is 0.5 mm in diameter at the level of the internal ring. In supra-inguinal approach, an artery sparing varicocelectomy may not offer any advantage in regards to catch-up growth and is associated with a higher incidence of recurrent varicocele. The success rates of the treatment (disappearance of varicocele) were between 85.1% and 100%. Whereas the complication rates were between 0% and 29% in the included studies. The most common complication reported was hydrocele. Resolution of pain after treatment was more than 90% in the reported series.
-
-
-
Yi-Yang LiuTaiwan
Speaker
Complex Renal Stone: PCNL or RIRS or Combination?Mini-percutaneous nephrolithotomy (mini-PCNL) provides stone-free rate (SFR) 85 to 95 % in children with complex burdens, and recent systematic reviews report overall complications < 7 % and transfusion requirements ≈3 % when tracts ≤18 Fr are used. Its drawbacks are the need for percutaneous access, risk of bleeding, and potential parenchymal scarring, especially when multiple tracts are required.
Retrograde intrarenal surgery (RIRS) avoids renal puncture and shows the lowest incidence of high-grade complications (<1 %); contemporary series in preschool children describe initial SFRs of 60–78 %, with secondary procedures needed in up to one-third of cases because of narrow, tortuous ureters. Pre-stenting, staged dilation and longer operative time can offset its minimally-invasive appeal for stones ≥2 cm.
Endoscopic combined intrarenal surgery (ECIRS) merges an antegrade mini-PCNL channel with simultaneous flexible ureteroscopy. The first multicenter pediatric series and a 2024 comparative study confirm SFRs of 75–92 %, shorter hospital stay and lower fluoroscopy or transfusion risk than standalone PCNL despite treating more complex stones. Its limitations are the need for two skilled teams, specialized equipment and the Galdakao-modified supine Valdivia position, which lengthen setup and raise costs.
In summary, mini-PCNL remains the most efficient monotherapy for large or staghorn calculi; RIRS is ideal when bleeding risk or unfavorable percutaneous windows predominate; ECIRS offers the best compromise between clearance and morbidity where resources and expertise allow. Individualized, anatomy-based algorithms and further pediatric RCTs are still required.
ECIRSIn this session, we will demonstrate the technique about Totally-X-ray free ultrasound guided endoscopic combind intrarenal surgery in Galdakao modified supine Valdivia position.A Critical Appraisal on Percutaneous NephrolithotripsyPercutaneous nephrolithotripsy (PCNL) has evolved from a uniform prone, fluoroscopy-guided, large-tract technique into a precision endourological platform that emphasizes patient-tailored positioning, radiation-free puncture, miniaturized tracts, energy-efficient lasers and nascent robotic–AI augmentation. Contemporary evidence affirms that stone-free rates now approach a plateau, making safety metrics—bleeding control, infection prevention and intrarenal pressure modulation—the key differentiators among modern approaches. Miniaturized optics, suction-regulated sheaths and thulium-fiber or dual-wavelength laser consoles have collectively reduced hemoglobin loss and postoperative sepsis while preserving clearance efficacy. Future success will hinge on harmonizing technological innovation with rigorous evidence so that every incremental advance translates into measurable gains for both efficacy and safety in stone surgery.Echo guide Puncture in Supine PCNL: Tips and Tricks for an Efficient and Safe ProcedureMastery of ultrasound-guided supine PCNL begins with precise anatomical orientation. Color-Doppler mapping pinpoints the target calyx, which is punctured transpapillary with an echogenic-tip needle after artificial hydronephrosis is produced by retrograde ureteroscopic irrigation. A hydrophilic, floppy-tip yet stiff-shaft guidewire is then advanced through the needle, allowing atraumatic navigation of the collecting system under ureteroscopic visualization. Balloon dilation—used in place of sequential dilators—prevents guidewire dislodgement. When necessary, a through-and-through guidewire from flank skin to urethral meatus may be created to secure renal access. Finally, antegrade nephroscopy along this coaxial tract confirms unobstructed entry, provides panoramic inspection, and optimizes lithotripsy efficiency—all without fluoroscopy. Collectively, these steps deliver reliable access, eliminate radiation, and streamline stone clearance in a single, ergonomically favorable supine position.
-
-
-
-
Jesun Lin Taiwan
Speaker
Distal Hypospadias: To Do or Not to Do Surgery?
Distal hypospadias repair: To do? Or Not to do Surgery?
Jesun Lin, M.D., Ph.D., M.H.A.
The definition of Distal Hypospadias: The patients who had glanular, coronal, and subcoronal meatus, were accepted as distal hypospadias cases. This is a retrospective study. In this study, 638 consecutive patients that had been undergone the operation for distal hypospadias repair in the department of pediatric urology of Changhua Christian Pediatric Hospital and Changhua Christian Hospital between September 1980 and December 2024. The ratio of distal type is 53% in the total hypospadias patients. The timing of operation is from infancy to adult according to the individual condition of the patients. The reasons of operation and not to do surgery are according to the variation of the types of distal hypospadias and family members expectations.
Distal hypospadias repair has several operative strategies such as Meatoplasty and Glanuloplasty (MAGPI), tubularized incised plate (TIP); Transverse preputial onlay flap (TPOF) and Modified Flip-Flap Procedure (Mathieu, Horton and Devine). Complications developed in 68 (11.0%) patients: 49 urethral fistulas, 11meatal stenosis with bifid urine stream, and 8 anastomotic stenosis.
There are literatures talking about stent and non-stent for the reconstruction. A systematic review to assess the complication rates of non-stented compared to the stented distal hypospadias repair is likely no outcome difference. We performed double-tube stent for eliminating stent-related bladder spasm, prevention of dysuria and obstruction after surgery.
IN my personal experience, the formation of neo-urethra corpus spongiosum improves the success rate regardless of the surgical methods. Although the current evidence of low to moderate quality suggests that there is likely no outcome difference between non-stented and stented distal hypospadias repair. The final consents are the chordee correction, nature urination with satisfied urine stream and appearance of the penis. We have to follow up the patient with photo and video after discharge periodically.
-
-
TICC - 2F 201AF
|
|
15:30
17:00
|
Oncology Bladder UTUC (B)
TICC - 1F 101A
|
Current Trends in Management of Advanced Urothelial Carcinoma
TICC - 1F 101B
|
Innovations in Urolithiasis Treatment: Clinical Evidence on mediNiK and Insights of Hydrogel-Suction Synergy
TICC - 1F 101C
|
Oncology RCC (A)
Cheryn SongKorea (Republic of)
Moderator
Assistance of the AI during RAPN - Surgical Navigation to Outcome PredictionArtificial Intelligence (AI) has deeply infiltrated many, if not every, aspects of our lives - both professional and ordinary corners. In medicine, it seems that any research dealing with large amounts of data has to employ AI in one way or another - from radiomics and radiogenomics to drug developments and simulations. In managing patients with renal tumors, majority of which now present with localized, small masses, I have focused on developing a tool to help establish a plan preoperatively and navigate throughout the surgery, in real-time with the help of the AI. Using kidney dynamic CT scans of 100 patients undergoing robot-assisted partial nephrectomy, software was developed to render a 3-dimensional image of the kidney harboring the tumor along with several other tools to enhance visualization of the lesion. Scans from an additional 30 patients were used to test for performance and validate the software. Before surgery, main renal pedicles, tumor location with respect to the major hilar vasculature, important landmarks including the calyces and branches of the vessels can be studied from all angles; tumor shape especially when it is not a perfect sphere can be visually presented and the excision of the tumor with desired margin thickness can be simulated to see what vital structures come into contact. Connected to the surgeon console through the TilePro® screen, it was designed to aid a urologic surgeon from before surgery as well as throughout the procedure as needed. In a phase I feasibility trial investigating the efficacy of the system, we confirmed that the integration of the 3D navigation system into RAPN was both feasible and safe, providing enhanced anatomical information while maintaining a consistent level of operative risk. The use of navigation system resulted in reduced renal parenchymal volume resected, suggesting potential benefits in renal function preservation. Subsequent phase 2 trial investigating accuracy of the reconstruction and a multicenter randomized controlled trial with surgeons with varying degrees of experience are underway to validate the benefits.
On the other hand, the fundamental question as to best manage the small renal masses – i.e. indications for partial nephrectomies - still harbor some gray areas: is partial nephrectomy at all possible situations the best? In a given patient how will oncological and renal functional outcome differ between partial and radical nephrectomy? Previous statistical methods could only calculate risk ratios in the best-matched cohorts and the issue of counterfactual remained. Using demographic and tumor descriptive parameters of 1,448 patients with pT1N0M0 RCC patients from three academic centers, causal inference was modeled using a double machine learning algorithm to predict progression-free survival and eGFR at five years according to each surgical method: partial and radical nephrectomy. We identified significant factors and their contribution to the outcomes of interest to be included in the model. Selecting a model with the highest performance among various machine learning models for each outcome, an online interface was constructed. External validation confirmed the robustness, presenting AUROC of 0.758, AUPRC of 0.200 with XGBoost model for recurrence, and RMSE of 15.9 with GBM model for eGFR. By presenting numerical predictions of oncologic and functional outcomes associated with partial and radical nephrectomy in a given patient, our model facilitates individualized, evidence-based clinical decision-making.
TICC - 1F 101D
|
Pediatric Urology
Shang-Jen ChangTaiwan
Moderator
Which Surgical Treatment is Best for UPJO in Infants: Open, Laparoscopic, Robotic AssistedAbstract
Ureteropelvic junction obstruction (UPJO) in infants is a condition that can significantly impair renal function and requires timely surgical intervention when certain criteria are met, such as decreased split renal function, poor drainage on diuretic renography, or recurrent urinary tract infections. The three main surgical approaches for treating UPJO are open pyeloplasty (OP), laparoscopic pyeloplasty (LP), and robot-assisted laparoscopic pyeloplasty (RALP). Each technique has its own benefits and limitations, especially when applied to infants.
Minimally invasive surgery (MIS), including LP and RALP, has gained popularity in pediatric urology due to advantages such as shorter hospital stays, reduced postoperative pain, faster recovery, and better cosmetic outcomes. However, the small working space in infants, the steep learning curve, and higher costs are significant limitations. In particular, the utility of MIS in infants remains controversial due to undefined benefits and technical challenges, including limited space for trocar placement and difficulty in intracorporeal suturing.
Current guidelines from the European Association of Urology (EAU) indicate that while RALP is considered the gold standard for older pediatric patients, its role in infants remains less defined due to anatomical and logistical constraints. Open surgery continues to be the mainstay for infantile UPJO due to its well-established success rate and lower cost.
Several studies have addressed the learning curve associated with these techniques. Laparoscopic pyeloplasty requires about 30 cases for a surgeon to achieve proficiency, while RALP demands approximately 18–31 cases depending on the metrics used. Simulation-based training, dry labs, and multicenter collaboration are proposed solutions to accelerate skill acquisition and ensure patient safety.
Cost is another critical consideration. Although RALP generally incurs higher upfront costs, especially in low-volume centers, innovations such as magnetic stents have helped offset some of these expenses by eliminating the need for anesthesia during stent removal. Moreover, the availability of pediatric-specific robotic instruments remains limited and necessitates ongoing development to fully support MIS in smaller patients.
In conclusion, while RALP is increasingly recognized as the standard for pediatric UPJO, its application in infants should be considered selectively, depending on surgeon experience, institutional resources, and patient anatomy. Open pyeloplasty remains a safe and effective option, particularly in very young children. Advances in surgical training, cost reduction strategies, and instrument development will be key to expanding the use of minimally invasive techniques in this population.
TICC - 1F 102
|
|
15:30
17:00
|
Oncology: RCC & Miscellaneous
TICC - 3F South Lounge
|
Pediatric Urology & Infectious Disease
Yu-Chen ChenTaiwan
Moderator
What We Should Know about Sexual Development Disorders Disorders of Sexual Development (DSDs) represent a spectrum of congenital conditions involving atypical development of chromosomal, gonadal, or anatomical sex. Early identification and accurate diagnosis are essential for guiding clinical management and psychosocial support. This talk will provide an overview of the classification of DSDs, including 46,XX DSD, 46,XY DSD, and sex chromosome DSDs, and highlight key diagnostic steps such as hormonal profiling, genetic testing, and imaging studies. Common conditions such as congenital adrenal hyperplasia (CAH), androgen insensitivity syndrome (AIS), and gonadal dysgenesis will be discussed, with emphasis on a multidisciplinary approach involving pediatric endocrinologists, geneticists, surgeons, and psychologists. Practical considerations in gender assignment, surgical timing, and long-term follow-up will also be addressed. This session aims to equip urology residents with the essential knowledge to recognize and contribute to the care of patients with DSDs.
TICC - 3F North Lounge
|
Oncology Prostate (C)
Chang Wook JeongKorea (Republic of)
Moderator
Extravasculare Renal Denervation to Treat Resistant HypertensionResistant hypertension is defined as uncontrolled blood pressure above the target, despite the concurrent use of three or more antihypertensive medications. Individuals with resistant hypertension are at a high risk for severe cardiovascular events and mortality. Managing resistant hypertension is challenging, and many non-pharmacological treatments, including renal denervation (RDN), have been introduced.
This presentation will demonstrate the surgical technique of the extravascular RDN (eRDN) using the HyperQure™ System performed as part of the first-in-human trial. The surgeries were performed as a retroperitoneal approach in a modified prone position.
The preliminary results will be presented, too. In the United States, a prospective, multicenter, early feasibility study is also underway.
TICC - 4F Elegance Lounge
|
Bladder UTUC (C)
TICC - 4F Joy Lounge
|
Novel Advances (B): Bladder
Jian-Ri LiTaiwan
Moderator
Applying Vision Augmentation in Robotic Surgery: Reality or FictionApplying Vision Augmentation in Robotic Surgery: Reality or Fiction
Seong Il SeoKorea (Republic of)
Moderator
Comparison of Remal Function between Radiofrequency Ablation versus Robot Assisted Laparoscopic Patial Nephrectomy for Small Renal Mass in Elderly PatientsComparison of renal function between radiofrequency ablation versus robot assisted laparoscopic partial nephrectomy for small renal mass in elderly patients
Jiwoong Yu, Seongil Seo
Sungkyunkwan University, Samsung Medical Center
The incidence of small renal masses (SRMs) in patients ≥75 years has increased up to 30-fold [J Urol 2014]. In this age group, treatment should balance cancer control and renal function preservation. Robot-assisted partial nephrectomy (RAPN) and radiofrequency ablation (RFA) are two main options.
RAPN offers excellent cancer control but requires general anesthesia and ischemia, which may pose risks in older patients. RFA is less invasive, avoids vascular clamping, and is often preferred for high-risk patients, as supported by EAU and AUA guidelines.
RFA generally preserves renal function better [Front Oncol 2022], though outcomes vary by technique. At our center, RFA under general anesthesia with wide safety margins may compromise parenchymal preservation.
While both approaches show favorable cancer control, RFA has a slightly higher recurrence rate. Pantelidou et al. reported 6 recurrences in 63 RFA cases vs. 1 in 63 RAPN cases [Cardiovasc Intervent Radiol 2016], and Park et al. reported 2-year recurrence-free survival (RFS) of 95.2% in RFA vs. 100% in RAPN [Eur Radiol 2018]. NCCN guidelines note that RFA may require repeat treatment to match surgical outcomes.
Our institutional matched analysis (63 RAPN vs. 63 RFA) showed RFS of 100% vs. 95.2% (p = 0.029), and immediate eGFR preservation of 91.7% vs. 86.8% [Eur Radiol 2018;28:2979–2985]. A subsequent analysis of older patients presented at AUA 2024 included 137 patients aged ≥75, the rate of ≥25% eGFR decline at one year was 28.6% for RFA vs. 2.0% for RAPN (HR 11.3, p = 0.002), with 4 recurrences in RFA and none in RAPN.
In conclusion, both RFA and RAPN are viable options for elderly patients with small renal masses. RFA is less invasive but may carry a slightly higher risk of recurrence and, depending on institutional technique, some degree of renal function loss. Treatment should be individualized based on tumor anatomy, patient condition, and institutional expertise.
TWTC - 1F Exhibition Hall
|
